Systems and methods for detecting leaks

ABSTRACT

Various embodiments disclosed herein relate to detecting leaks in a patient monitoring system. The system can include a fluid handling network configured to receive a fluid sample drawn from a patient and to deliver at least a portion of the fluid sample to an analyte measurement system. The system can isolate at least a portion of the fluid handling network, can apply pressure to the at least a portion of the fluid handling network, can measure the pressure in the at least a portion of the fluid handling network, and can determine whether a leak is present in the at least a portion of the fluid handling network based at least in part on the measured pressure.

CROSS-REFERENCE TO RELATED APPLICATIONS

This applications is a continuation of U.S. patent application Ser. No.14/573,868, filed Dec. 17, 2014, and titled SYSTEMS AND METHODS FORDETECTING LEAKS, which claims the benefit under 35 U.S.C. § 119(e) ofU.S. Provisional Patent Application No. 61/917,745, filed Dec. 18, 2013,and titled SYSTEMS AND METHODS FOR DETECTING LEAKS, the entirety of eachof which is hereby incorporated by reference and made a part of thisspecification for all that it discloses.

BACKGROUND Field

Some embodiments of the disclosure relate generally to methods anddevices for determining a concentration of an analyte in a sample, suchas an analyte in a sample of bodily fluid, as well as methods anddevices which can be used to support the making of such determinations.Some embodiments of the disclosure relate to a sample cell for holding asample fluid.

Description of Related Art

It is advantageous to measure the levels of certain analytes, such asglucose, in a bodily fluid, such as blood). This can be done, forexample, in a hospital or clinical setting when there is a risk that thelevels of certain analytes may move outside a desired range, which inturn can jeopardize the health of a patient. Currently known systems foranalyte monitoring in a hospital or clinical setting may suffer fromvarious drawbacks.

SUMMARY

Example embodiments described herein have several features, no singleone of which is indispensible or solely responsible for their desirableattributes. Without limiting the scope of the claims, some of theadvantageous features will now be summarized.

Various embodiments disclosed herein can relate to a bodily fluid sampleanalysis system, which can include an analyte measurement systemconfigured to determine the concentration of an analyte in a bodilyfluid and a fluid handling network comprising a plurality of tubes andat least one junction between the plurality of tubes. The fluid handlingnetwork can include a patient end configured to receive bodily fluiddrawn from a patient, and the fluid handling network can be configuredto provide at least a portion of the drawn bodily fluid to the analytemeasurement system. The system can include an arrival sensor configuredto detect the arrival of the bodily fluid at a location in the fluidhandling network, one or more valves having a closed position and anopen position, one or more pumps configured to apply pressure to thefluid handling network, and at least one pressure sensor configured tomeasure pressure in the fluid handling network. The system can include acontroller that is configured to actuate at least one of the one or morepumps to draw bodily fluid from a patient through the patient end intothe fluid handling network and to transport the bodily fluid to thelocation in the fluid handling network associated with the arrivalsensor, receive data from the arrival sensor indicating the arrival ofthe bodily fluid at the location, determine whether the fluid handlingnetwork is leaking based at least in part on the time that the bodilyfluid arrived at the location associated with the arrival sensor, closeat least one of the one or more valves to block fluid flow through atube between the patient end and the at least one junction, applypressure to the fluid handling network using the one or more pumps,receive data from the at least one pressure sensor regarding a pressurein the fluid handling network, confirm whether the fluid handlingnetwork is leaking based at least in part on the data received from theat least one pressure sensor, actuate the one or more valves to isolatea portion of the fluid handling network, apply pressure to the isolatedportion of the fluid handling network using the one or more pumps,receive data from the at least one pressure sensor regarding a pressurein the isolated portion of the fluid handling network, and determinewhether the isolated portion of the fluid handling network is leakingbased at least in part on the data received from the at least onepressure sensor.

The controller can be configured to determine whether the fluid handlingnetwork is leaking based at least in part on the time it takes for thebodily fluid to move from a starting point to the location associatedwith the arrival sensor. The system can include a second arrival sensorthat can be configured to detect the arrival of the bodily fluid at thestarting point, and the controller can be configured to receive datafrom the second arrival sensor indicating the arrival of the bodilyfluid at the starting point. The starting point can be a junction in thefluid handling network and a start time can include the time that thebodily fluid is drawn through the junction.

The controller can be configured to determine whether the fluid handlingnetwork is leaking by comparing the time that the bodily fluid arrivedat the location with an acceptable time threshold. The controller can beconfigured to determine whether the fluid handling network is leaking bycomparing the time that the bodily fluid arrived at the location withone or more arrival times from one or more previous measurement cycles.

The controller can be configured to cause a sample of bodily fluid to bereceived into the fluid handling network after determining that thefluid handling network is not leaking. The controller can be configuredto post an alarm after determining that the fluid handling network isleaking. The system can be configured to perform a plurality ofmeasurement cycles, and the system can be configured to check the fluidhandling network for leaks before receiving a fluid sample into thefluid handling network for each measurement cycle.

The controller can be configured to isolate a first portion of the fluidhandling network, apply pressure to the first portion of the fluidhandling network, measure a pressure in the first portion of the fluidhandling network, isolate a second portion of the fluid handlingnetwork, apply pressure to the second portion of the fluid handlingnetwork, measure a pressure in the second portion of the fluid handlingnetwork, and determine a location of a leak based at least in part onthe measured pressure of the first portion of the fluid handling networkand the measured pressure of the second portion of the fluid handlingnetwork. The first portion of the fluid handling network can overlap atleast part of the second portion of the fluid handling network, in someembodiments. The first portion of the fluid handling network and thesecond portion of the fluid handling network do not overlap, in someembodiments. The controller can be configured to determine whether aleak is present in the first portion of the fluid handling network basedat least in part on the measured pressure in the first portion of thefluid handling network, and to determine whether a leak is present inthe second portion of the fluid handling network based at least in parton the measured pressure in the second portion of the fluid handlingnetwork. The controller can be configured to output an indicator of thelocation of the leak.

The controller can be configured to apply more pressure to the fluidhandling network when testing for leaks than when providing the at leasta portion of the fluid sample to the analyte measurement system.

The analyte can be glucose. The fluid sample can be whole blood.

Various embodiments disclosed herein relate to a patient monitoringsystem, which can include an analyte measurement system configured todetermine the concentration of an analyte in a bodily fluid. The systemcan include a fluid handling network including a plurality of tubes andat least one junction between the plurality of tubes. The fluid handlingnetwork can include a patient end configured to receive bodily fluiddrawn from a patient. The fluid handling network can be configured toprovide at least a portion of the drawn bodily fluid to the analytemeasurement system. The system can include a valve having a closedposition and an open position. The closed position blocks fluid flowthrough a tube between the patient end and the at least one junction,and the open position can permit fluid flow through the tube between thepatient end and the at least one junction. The system can include atleast one pump configured to apply pressure to the fluid handlingnetwork. The system can include at least one pressure sensor configuredto measure pressure in the fluid handling network. The system caninclude a controller, which can be configured to close the valve toblock fluid flow through a tube between the patient end and the at leastone junction, apply pressure to fluid handling network using the atleast one pump, receive data from the at least one pressure sensorregarding a pressure in the fluid handling network, and determinewhether the fluid handling network is leaking based at least in part onthe data received from the at least one pressure sensor.

In some embodiments, the controller can be configured to cause a sampleof bodily fluid to be drawn into the fluid handling network afterdetermining that the fluid handling network is not leaking. Thecontroller can be configured to post an alarm after determining that thefluid handling network is leaking.

The system can be configured to perform a plurality of measurementcycles, and the system can be configured to check the fluid handlingnetwork for leaks before drawing bodily fluid into the fluid handlingnetwork for each measurement cycle.

The controller can be configured to actuate one or more valves toisolate a first portion of the fluid handling network, apply pressure tothe first portion of the fluid handling network using the at least onepump, measure a pressure in the first portion of the fluid handlingnetwork using the at least one pressure sensor, actuate the one or morevalves to isolate a second portion of the fluid handling network, applypressure to the second portion of the fluid handling network using theat least one pump, measure a pressure in the second portion of the fluidhandling network using the at least one pressure sensor, and determine alocation of a leak based at least in part on the measured pressure ofthe first portion of the fluid handling network and the measuredpressure of the second portion of the fluid handling network. In someembodiments, the first portion of the fluid handling network overlaps atleast part of the second portion of the fluid handling network. In someembodiments, the first portion of the fluid handling network and thesecond portion of the fluid handling network do not overlap. Thecontroller can be configured to determine whether a leak is present inthe first portion of the fluid handling network based at least in parton the measured pressure in the first portion of the fluid handlingnetwork and determine whether a leak is present in the second portion ofthe fluid handling network based at least in part on the measuredpressure in the second portion of the fluid handling network. Thecontroller can be configured to output an indicator of the location ofthe leak.

The controller can be configured to apply more pressure to the fluidhandling network when testing for leaks than when drawing bodily fluidor when providing the at least a portion of the drawn bodily fluid tothe analyte measurement system.

The analyte can include glucose. The bodily fluid can include wholeblood.

Various embodiments disclosed herein relate to a method for detecting aleak in a patient monitoring system. The method can include drawingbodily fluid from a patient, through a patient end, and into a fluidhandling network that includes a plurality of tubes and at least onejunction between the plurality of tubes. The method can includetransporting at least a portion of the drawn bodily fluid through thefluid handling network to a sample cell that is accessible to an analytemeasurement system. The method can include measuring the concentrationof an analyte in the at least a portion of the drawn bodily fluid usingthe analyte measurement system. The method can include testing the atleast one junction for a leak after measuring the concentration of theanalyte. Testing the fluid handling network for the leak can includeblocking fluid flow between the patient end and the at least onejunction, applying pressure to the at least one junction, measuring apressure associated with the at least one junction, determining whetherthe at least one junction is leaking based at least in part on themeasured pressure.

The method can include determining the at least one junction is notleaking, drawing a second sample of bodily fluid from a patient, throughthe patient end, and into the fluid handling network, transporting atleast a portion of the second sample of bodily fluid through the fluidhandling network to the sample cell, and measuring the concentration ofthe analyte in the at least a portion of the second sample of bodilyfluid using the analyte measurement system. The method can includedetermining the at least one junction is leaking and posting an alarm.The method can include drawing a plurality of additional samples ofbodily fluid from the patient and checking the fluid handling networkfor leaks before drawing each of the plurality of additional samples.

The method can include isolating a first portion of the fluid handlingnetwork, applying pressure to the first portion of the fluid handlingnetwork, measuring a pressure in the first portion of the fluid handlingnetwork, determining whether a leak is present in the first portion ofthe fluid handling network based at least in part on the measuredpressure in the first portion of the fluid handling network, isolating asecond portion of the fluid handling network, applying pressure to thesecond portion of the fluid handling network, measuring a pressure inthe second portion of the fluid handling network, determining whether aleak is present in the second portion of the fluid handling networkbased at least in part on the measured pressure in the second portion ofthe fluid handling network, and determining a location of a leak basedat least in part on the determinations of whether a leak is present inthe first portion and the second portion of the fluid handling network.The first portion of the fluid handling network can overlap at leastpart of the second portion of the fluid handling network, or the firstportion of the fluid handling network and the second portion of thefluid handling network do not overlap. The method can include outputtingan indicator of the location of the leak.

The pressure applied to the at least one junction to determine whetherthe at least one junction is leaking can be greater than pressureapplied to the at least one junction during the drawing of bodily fluidfrom the patient and/or during the transporting of at least a portion ofthe drawn bodily fluid to the sample cell.

The analyte can include glucose. The bodily fluid can include wholeblood.

Various embodiment disclosed herein can relate to a fluid sampleanalysis system. The system can include an analyte measurement systemconfigured to determine the concentration of an analyte in a fluidsample and a fluid handling network configured to receive a fluid sampleand to provide at least a portion of the fluid sample to the analytemeasurement system. The system can include one or more valves having aclosed position and an open position and at least one pump configured toapply pressure to the fluid handling network. The system can include atleast one pressure sensor configured to measure pressure in the fluidhandling network. The system can include a controller configured toactuate the one or more valves to isolate a portion of the fluidhandling network, apply pressure to the isolated portion of the fluidhandling network using the at least one pump, receive data from the atleast one pressure sensor regarding a pressure in the isolated portionof the fluid handling network, and determine whether the isolatedportion of the fluid handling network is leaking based at least in parton the data received from the at least one pressure sensor.

The controller can be configured to cause a fluid sample to be receivedinto the fluid handling network after determining that the fluidhandling network is not leaking. The controller can be configured topost an alarm after determining that the fluid handling network isleaking.

The system can be configured to perform a plurality of measurementcycles, and the system can be configured to check the fluid handlingnetwork for leaks before receiving a fluid sample into the fluidhandling network for each measurement cycle.

The controller can be configured to isolate a first portion of the fluidhandling network, apply pressure to the first portion of the fluidhandling network, measure a pressure in the first portion of the fluidhandling network, isolate a second portion of the fluid handlingnetwork, apply pressure to the second portion of the fluid handlingnetwork, measure a pressure in the second portion of the fluid handlingnetwork, and determine a location of a leak based at least in part onthe measured pressure of the first portion of the fluid handling networkand the measured pressure of the second portion of the fluid handlingnetwork. The first portion of the fluid handling network can overlap atleast part of the second portion of the fluid handling network, or thefirst portion of the fluid handling network and the second portion ofthe fluid handling network do not overlap. The controller can beconfigured to determine whether a leak is present in the first portionof the fluid handling network based at least in part on the measuredpressure in the first portion of the fluid handling network and todetermine whether a leak is present in the second portion of the fluidhandling network based at least in part on the measured pressure in thesecond portion of the fluid handling network. The controller can beconfigured to output an indicator of the location of the leak.

The controller can be configured to apply more pressure to the fluidhandling network when testing for leaks than when providing the at leasta portion of the fluid sample to the analyte measurement system.

The analyte an include glucose. The fluid sample can include wholeblood.

Various embodiments disclosed herein can relate to a patient monitoringsystem, which can include an analyte measurement system configured todetermine the concentration of an analyte in a bodily fluid and a fluidhandling network comprising a plurality of tubes. The fluid handlingnetwork can be configured to draw bodily fluid from a patient and toprovide at least a portion of the drawn bodily fluid to the analytemeasurement system. The system can include an arrival sensor configuredto detect the arrival of the bodily fluid at a location in the fluidhandling network. A controller can be configured to actuate at least onepump to draw bodily fluid from a patient into the fluid handling networkand to transport the bodily fluid to the location in the fluid handlingnetwork associated with the arrival sensor, receive data from thearrival sensor indicating the arrival of the bodily fluid at thelocation, and determine whether the fluid handling network is leakingbased at least in part on the time that the bodily fluid arrived at thelocation associated with the arrival sensor.

The controller can be configured to determine whether the fluid handlingnetwork is leaking based at least in part on the time it takes for thebodily fluid to move from a starting point to the location associatedwith the arrival sensor. The system can include a second arrival sensorconfigured to detect the arrival of the bodily fluid at the startingpoint, and the controller can be configured to receive data from thesecond arrival sensor indicating the arrival of the bodily fluid at thestarting point. In some embodiments, the starting point can be ajunction (e.g., between tubes) in the fluid handling network and whereina start time comprises the time that the bodily fluid is drawn throughthe junction.

The controller can be configured to determine whether the fluid handlingnetwork is leaking by comparing the time that the bodily fluid arrivedat the location with an acceptable time threshold. The controller can beconfigured to determine whether the fluid handling network is leaking bycomparing the time that the bodily fluid arrived at the location withone or more arrival times from one or more previous measurement cycles.

Various embodiment disclosed herein can relate to a method of detectinga leak in a fluid sample analysis system. The method can includeproviding a fluid sample to a fluid sample analysis system. The fluidsample analysis system can include an analyte measurement systemconfigured to determine the concentration of an analyte in the fluidsample and a fluid handling network comprising a plurality of tubes. Thefluid handling network can be configured to receive the fluid sample andto provide at least a portion of the fluid sample to the analytemeasurement system. The system can include an arrival sensor configuredto detect the arrival of the fluid sample at a location in the fluidhandling network. The method can include transporting a fluid samplefrom a starting point to the location in the fluid handling network thatis associated with the arrival sensor, detecting the arrival of thefluid sample at the location associated with the arrival sensor, anddetermining whether the fluid handling network has a leak based at leastin part on a time it took for the fluid sample to move from the startingpoint to the location in the fluid handling network that is associatedwith the arrival sensor.

The method can include detecting the arrival of the fluid sample at thestarting point using a second arrival sensor configured to detect thearrival of the fluid sample at the starting point. The starting pointcan be a junction in the fluid handling network, and the method caninclude defining a start time as the time that the fluid sample movesthrough the junction.

The method can include determining whether the fluid handling networkhas a leak by comparing the time it took for the fluid sample to movefrom the starting point to the location to an acceptable time threshold.The method can include determining whether the fluid handling networkhas a leak by comparing the time it took for the fluid sample to movefrom the starting point to the location to one or more arrival timesfrom one or more previous measurement cycles.

BRIEF DESCRIPTION OF THE DRAWINGS

The following drawings and the associated descriptions are provided toillustrate embodiments of the present disclosure and do not limit thescope of the claims.

FIG. 1 shows an embodiment of an apparatus for withdrawing and analyzingfluid samples.

FIG. 2 illustrates how various other devices can be supported on or nearan embodiment of apparatus illustrated in FIG. 1.

FIG. 3 illustrates an embodiment of the apparatus in FIG. 1 configuredto be connected to a patient.

FIG. 3A illustrates an embodiment of the apparatus in FIG. 1 that is notconfigured to be connected to a patient but which receives a fluidsample from an extracorporeal fluid container such as, for example, atest tube. This embodiment of the apparatus advantageously provides invitro analysis of a fluid sample.

FIG. 4 is a block diagram of an embodiment of a system for withdrawingand analyzing fluid samples.

FIG. 5 schematically illustrates an embodiment of a fluid system thatcan be part of a system for withdrawing and analyzing fluid samples.

FIG. 6 schematically illustrates another embodiment of a fluid systemthat can be part of a system for withdrawing and analyzing fluidsamples.

FIG. 7 is an oblique schematic depiction of an embodiment of amonitoring device.

FIG. 8 shows a cut-away side view of an embodiment of a monitoringdevice.

FIG. 9 shows a cut-away perspective view of an embodiment of amonitoring device.

FIG. 10 illustrates an embodiment of a removable cartridge that caninterface with a monitoring device.

FIG. 11 illustrates an embodiment of a fluid routing card that can bepart of the removable cartridge of FIG. 10.

FIG. 12 illustrates how non-disposable actuators can interface with thefluid routing card of FIG. 11.

FIG. 13 illustrates a modular pump actuator connected to a syringehousing that can form a portion of a removable cartridge.

FIG. 14 shows a rear perspective view of internal scaffolding and somepinch valve pump bodies.

FIG. 15 shows an underneath perspective view of a sample cell holderattached to a centrifuge interface, with a view of an interface with asample injector.

FIG. 16 shows a plan view of a sample cell holder with hidden and/ornon-surface portions illustrated using dashed lines.

FIG. 17 shows a top perspective view of the centrifuge interfaceconnected to the sample holder.

FIG. 18 shows a perspective view of an example optical system.

FIG. 19 shows a filter wheel that can be part of the optical system ofFIG. 18.

FIG. 20 schematically illustrates an embodiment of an optical systemthat comprises a spectroscopic analyzer adapted to measure spectra of afluid sample.

FIG. 21 is a flowchart that schematically illustrates an embodiment of amethod for estimating the concentration of an analyte in the presence ofinterferents.

FIG. 22 is a flowchart that schematically illustrates an embodiment of amethod for performing a statistical comparison of the absorptionspectrum of a sample with the spectrum of a sample population andcombinations of individual library interferent spectra.

FIG. 23 is a flowchart that schematically illustrates an exampleembodiment of a method for estimating analyte concentration in thepresence of the possible interferents.

FIGS. 24 and 25 schematically illustrate the visual appearance ofembodiments of a user interface for a system for withdrawing andanalyzing fluid samples.

FIG. 26 schematically depicts various components and/or aspects of apatient monitoring system and the relationships among the componentsand/or aspects.

FIG. 27 is a flowchart that schematically illustrates an embodiment of amethod of providing glycemic control.

FIG. 28 is a flowchart showing an example embodiment of a method formonitoring a patient while checking for leaks in the monitoring system.

FIG. 29 is a flowchart showing an example embodiment of a method fordetecting whether a leak is present in a fluid handling network.

FIG. 30 is a flowchart showing an example embodiment of a method foridentifying a location of a leak in the fluid handling network.

These and other features will now be described with reference to thedrawings summarized above. The drawings and the associated descriptionsare provided to illustrate embodiments and not to limit the scope of anyclaim. Throughout the drawings, reference numbers may be reused toindicate correspondence between referenced elements. In addition, whereapplicable, the first one or two digits of a reference numeral for anelement can frequently indicate the figure number in which the elementfirst appears.

DETAILED DESCRIPTION

Although certain preferred embodiments and examples are disclosed below,inventive subject matter extends beyond the specifically disclosedembodiments to other alternative embodiments and/or uses and tomodifications and equivalents thereof. Thus, the scope of the claimsappended hereto is not limited by any of the particular embodimentsdescribed below. For example, in any method or process disclosed herein,the acts or operations of the method or process may be performed in anysuitable sequence and are not necessarily limited to any particulardisclosed sequence. Various operations may be described as multiplediscrete operations in turn, in a manner that may be helpful inunderstanding certain embodiments; however, the order of descriptionshould not be construed to imply that these operations are orderdependent. Additionally, the structures, systems, and/or devicesdescribed herein may be embodied as integrated components or as separatecomponents. For purposes of comparing various embodiments, certainaspects and advantages of these embodiments are described. Notnecessarily all such aspects or advantages are achieved by anyparticular embodiment. Thus, for example, various embodiments may becarried out in a manner that achieves or optimizes one advantage orgroup of advantages as taught herein without necessarily achieving otheraspects or advantages as may also be taught or suggested herein.

The systems and methods discussed herein can be used anywhere,including, for example, in laboratories, hospitals, healthcarefacilities, intensive care units (ICUs), or residences. Moreover, thesystems and methods discussed herein can be used for invasivetechniques, as well as non-invasive techniques or techniques that do notinvolve a body or a patient such as, for example, in vitro techniques.

Analyte Monitoring Apparatus

FIG. 1 shows an embodiment of an apparatus 100 for withdrawing andanalyzing fluid samples. The apparatus 100 includes a monitoring device102. In some embodiments, the monitoring device 102 can be an“OptiScanner®” monitor available from OptiScan Biomedical Corporation ofHayward, Calif. In some embodiments, the device 102 can measure one ormore physiological parameters, such as the concentration of one or moresubstance(s) in a sample fluid. The sample fluid can be, for example,whole blood from a patient 302 (see, e.g., FIG. 3) and/or a component ofwhole blood such as, e.g., blood plasma. In some embodiments, the device100 can also deliver an infusion fluid to a patient.

In the illustrated embodiment, the monitoring device 102 includes adisplay 104 such as, for example, a touch-sensitive liquid crystaldisplay. The display 104 can provide an interface that includes alerts,indicators, charts, and/or soft buttons. The device 102 also can includeone or more inputs and/or outputs 106 that provide connectivity and/orpermit user interactivity.

In the embodiment shown in FIG. 1, the device 102 is mounted on a stand108. The stand 108 may comprise a cart such as, for example, a wheeledcart 130 as shown in FIG. 1. In some embodiments, the stand 108 isconfigured to roll on a wheeled pedestal 240 (shown in FIG. 2). Thestand 108 advantageously can be easily moved and includes one or morepoles 110 and/or hooks 112. The poles 110 and hooks 112 can beconfigured to accommodate other medical devices and/or implements,including, for example, infusion pumps, saline bags, arterial pressuresensors, other monitors and medical devices, and so forth. Some standsor carts may become unstable if intravenous (IV) bags, IV pumps, andother medical devices are hung too high on the stand or cart. In someembodiments, the apparatus 100 can be configured to have a low center ofgravity, which may overcome possible instability. For example, the stand108 can be weighted at the bottom to at least partially offset theweight of IV bags, IV pumps and medical devices that may be attached tothe hooks 112 that are placed above the monitoring device 102. Addingweight toward the bottom (e.g., near the wheels) may help prevent theapparatus 100 from tipping over.

In some embodiments, the apparatus 100 includes the cart 130, which hasan upper shelf 131 on which the monitoring device 102 may be placed (orattached) and a bottom shelf 132 on which a battery 134 may be placed(or attached). The battery 134 may be used as a main or backup powersupply for the monitoring device 102 (which may additionally oralternatively accept electrical power from a wall socket). Two or morebatteries are used in certain embodiments. The apparatus 100 may beconfigured so that the upper and lower shelves 131, 132 are close toground level, and the battery provides counterweight. Other types ofcounterweights may be used. For example, in some embodiments, portionsof the cart 130 near the floor (e.g., a lower shelf) are weighted,formed from a substantial quantity of material (e.g., thick sheets ofmetal), and/or formed from a relatively high-density metal (e.g., lead).In some embodiments the bottom shelf 132 is approximately 6 inches to 1foot above ground level, and the upper shelf 131 is approximately 2 feetto 4 feet above ground level. In some embodiments the upper shelf 131may be configured to support approximately 40 pounds (lbs), and thebottom shelf 132 may be configured to support approximately 20 lbs. Onepossible advantage of embodiments having such a configuration is that IVpumps, bags containing saline, blood and/or drugs, and other medicalequipment weighing approximately 60 lbs, collectively, can be hung onthe hooks 112 above the shelves without making the apparatus 100unstable. The apparatus 100 may be moved by applying a horizontal forceon the apparatus 100, for example, by pushing and/or pulling the poles110. In many cases, a user may exert force on an upper portion of theapparatus 100, for example, close to shoulder-height. Bycounterbalancing the weight as described above, the apparatus 100 may bemoved in a reasonably stable manner.

In the illustrated embodiment, the cart 130 includes the bottom shelf132 and an intermediate shelf 133, which are enclosed on three sides bywalls and on a fourth side by a door 135. The door 135 can be opened (asshown in FIG. 1) to provide access to the shelves 132, 133. In otherembodiments, the fourth side is not enclosed (e.g., the door 135 is notused). Many cart variations are possible. In some embodiments thebattery 134 can be placed on the bottom shelf 134 or the intermediateshelf 133.

FIG. 2 illustrates how various other devices can be supported on or nearthe apparatus 100 illustrated in FIG. 1. For example, the poles 110 ofthe stand 108 can be configured (e.g., of sufficient size and strength)to accommodate multiple devices 202, 204, 206. In some embodiments, oneor more COLLEAGUE® volumetric infusion pumps available from BaxterInternational Inc. of Deerfield, Ill. can be accommodated. In someembodiments, one or more Alaris® PC units available from CardinalHealth, Inc. of Dublin, Ohio can be accommodated. Furthermore, variousother medical devices (including the two examples mentioned here), canbe integrated with the disclosed monitoring device 102 such thatmultiple devices function in concert for the benefit of one or multiplepatients without the devices interfering with each other.

FIG. 3 illustrates the apparatus 100 of FIG. 1 as it can be connected toa patient 302. The monitoring device 102 can be used to determine theconcentration of one or more substances in a sample fluid. The samplefluid can come can come from the patient 302, as illustrated in FIG. 3,or the sample fluid can come from a fluid container, as illustrated inFIG. 3A. In some preferred embodiments, the sample fluid is whole blood.

In some embodiments (see, e.g., FIG. 3), the monitoring device 102 canalso deliver an infusion fluid to the patient 302. An infusion fluidcontainer 304 (e.g., a saline bag), which can contain infusion fluid(e.g., saline and/or medication), can be supported by the hook 112. Themonitoring device 102 can be in fluid communication with both thecontainer 304 and the sample fluid source (e.g., the patient 302),through tubes 306. The infusion fluid can comprise any combination offluids and/or chemicals. Some advantageous examples include (but are notlimited to): water, saline, dextrose, lactated Ringer's solution, drugs,and insulin.

The example monitoring device 102 schematically illustrated in FIG. 3allows the infusion fluid to pass to the patient 302 and/or uses theinfusion fluid itself (e.g., as a flushing fluid or a standard withknown optical properties, as discussed further below). In someembodiments, the monitoring device 102 may not employ infusion fluid.The monitoring device 102 may thus draw samples without delivering anyadditional fluid to the patient 302. The monitoring device 102 caninclude, but is not limited to, fluid handling and analysis apparatuses,connectors, passageways, catheters, tubing, fluid control elements,valves, pumps, fluid sensors, pressure sensors, temperature sensors,hematocrit sensors, hemoglobin sensors, colorimetric sensors, gas (e.g.,“bubble”) sensors, fluid conditioning elements, gas injectors, gasfilters, blood plasma separators, and/or communication devices (e.g.,wireless devices) to permit the transfer of information within themonitoring device 102 or between the monitoring device 102 and anetwork.

In some embodiments, the apparatus 100 is not connected to a patient andmay receive fluid samples from a container such as a decanter, flask,beaker, tube, cartridge, test strip, etc., or any other extracorporealfluid source. The container may include a biological fluid sample suchas, e.g., a body fluid sample. For example, FIG. 3A schematicallyillustrates an embodiment of the monitoring device 102 that isconfigured to receive a fluid sample from one or more test tubes 350.This embodiment of the monitoring device 102 is configured to perform invitro analysis of a fluid (or a fluid component) in the test tube 350.The test tube 350 may comprise a tube, vial, bottle, or other suitablecontainer or vessel. The test tube 350 may include an opening disposedat one end of the tube through which the fluid sample may be added priorto delivery of the test tube to the monitoring device 102. In someembodiments, the test tubes 350 may also include a cover adapted to sealthe opening of the tube. The cover may include an aperture configured topermit a tube, nozzle, needle, pipette, or syringe to dispense the fluidsample into the test tube 350. The test tubes 350 may comprise amaterial such as, for example, glass, polyethylene, or polymericcompounds. In various embodiments, the test tubes 350 may be re-usableunits or may be disposable, single-use units. In certain embodiments,the test tubes 350 may comprise commercially available lowpressure/vacuum sample bottles, test bottles, or test tubes.

In the embodiment shown in FIG. 3A, the monitoring device 102 comprisesa fluid delivery system 360 configured to receive a container (e.g., thetest tube 350) containing a fluid sample and deliver the fluid sample toa fluid handling system (such as, e.g., fluid handling system 404described below). In some embodiments, the fluid handling systemdelivers a portion of the fluid sample to an analyte detection systemfor in vitro measurement of one or more physiological parameters (e.g.,an analyte concentration). Prior to measurement, the fluid handlingsystem may, in some embodiments, separate the fluid sample intocomponents, and a measurement may be performed on one or more of thecomponents. For example, the fluid sample in the test tube 350 maycomprise whole blood, and the fluid handling system may separate bloodplasma from the sample (e.g., by filtering and/or centrifuging).

In the embodiment illustrated in FIG. 3A, the fluid delivery system 360comprises a carousel 362 having one or more openings 364 adapted toreceive the test tube 350. The carousel 362 may comprise one, two, four,six, twelve, or more openings 364. In the illustrated embodiment, thecarousel 362 is configured to rotate around a central axis or spindle366 so that a test tube 350 inserted into one of the openings 364 isdelivered to the monitoring device 102. In certain embodiments, thefluid handling system of the monitoring device 102 comprises a samplingprobe that is configured to collect a portion of the fluid sample fromthe test tube 350 (e.g., by suction or aspiration). The collectedportion may then be transported in the device 102 as further describedbelow (see, e.g., FIGS. 4-7). For example, in one embodiment suitablefor use with whole blood, the collected portion of the whole bloodsample is transported to a centrifuge for separation into blood plasma,a portion of the blood plasma is transported to an infrared spectroscopefor measurement of one or more analytes (e.g., glucose), and themeasured blood plasma is then transported to a waste container fordisposal.

In other embodiments of the apparatus 100 shown in FIG. 3A, the fluiddelivery system 360 may comprise a turntable, rack, or caddy adapted toreceive the test tube 350. In yet other embodiments, the monitoringdevice 102 may comprise an inlet port adapted to receive the test tube350. Additionally, in other embodiments, the fluid sample may bedelivered to the apparatus 100 using a test cartridge, a test strip, orother suitable container. Many variations are possible.

In some embodiments, one or more components of the apparatus 100 can belocated at another facility, room, or other suitable remote location.One or more components of the monitoring device 102 can communicate withone or more other components of the monitoring device 102 (or with otherdevices) by communication interface(s) such as, but not limited to,optical interfaces, electrical interfaces, and/or wireless interfaces.These interfaces can be part of a local network, internet, wirelessnetwork, or other suitable networks.

System Overview

FIG. 4 is a block diagram of a system 400 for sampling and analyzingfluid samples. The monitoring device 102 can comprise such a system. Thesystem 400 can include a fluid source 402 connected to a fluid-handlingsystem 404. The fluid-handling system 404 includes fluid passageways andother components that direct fluid samples. Samples can be withdrawnfrom the fluid source 402 and analyzed by an optical system 412. Thefluid-handling system 404 can be controlled by a fluid system controller405, and the optical system 412 can be controlled by an optical systemcontroller 413. The sampling and analysis system 400 can also include adisplay system 414 and an algorithm processor 416 that assist in fluidsample analysis and presentation of data.

In some embodiments, the sampling and analysis system 400 is a mobilepoint-of-care apparatus that monitors physiological parameters such as,for example, blood glucose concentration. Components within the system400 that may contact fluid and/or a patient, such as tubes andconnectors, can be coated with an antibacterial coating to reduce therisk of infection. Connectors between at least some components of thesystem 400 can include a self-sealing valve, such as a spring valve, inorder to reduce the risk of contact between port openings and fluids,and to guard against fluid escaping from the system. Other componentscan also be included in a system for sampling and analyzing fluid inaccordance with the described embodiments.

The sampling and analysis system 400 can include a fluid source 402 (ormore than one fluid source) that contain(s) fluid to be sampled. Thefluid-handling system 404 of the sampling and analysis system 400 isconnected to, and can draw fluid from, the fluid source 402. The fluidsource 402 can be, for example, a blood vessel such as a vein or anartery, a container such as a decanter, flask, beaker, tube, cartridge,test strip, etc., or any other corporeal or extracorporeal fluid source.For example, in some embodiments, the fluid source 402 may be a vein orartery in the patient 302 (see, e.g., FIG. 3). In other embodiments, thefluid source 402 may comprise an extracorporeal container 350 of fluiddelivered to the system 400 for analysis (see, e.g., FIG. 3B). The fluidto be sampled can be, for example, blood, plasma, interstitial fluid,lymphatic fluid, or another fluid. In some embodiments, more than onefluid source can be present, and more than one fluid and/or type offluid can be provided.

In some embodiments, the fluid-handling system 404 withdraws a sample offluid from the fluid source 402 for analysis, centrifuges at least aportion of the sample, and prepares at least a portion of the sample foranalysis by an optical sensor such as a spectrophotometer (which can bepart of an optical system 412, for example). These functions can becontrolled by a fluid system controller 405, which can also beintegrated into the fluid-handling system 404. The fluid systemcontroller 405 can also control the additional functions describedbelow. In some embodiments, the sample can be withdrawn continuously orsubstantially continuously at certain time intervals with a givenperiod. The time intervals at which the sample is withdrawn can beperiodic or aperiodic and range from approximately 1 minute toapproximately 15 minutes (e.g., the sample can be withdrawn at timeintervals of 1 minute, 5 minutes, 10 minutes or 15 minutes). In someembodiments, the sample can be withdrawn at discrete time intervals(e.g., once every 30 minutes, once every 45 minutes or once every hour).

The duration of time over which the sample of fluid is withdrawn,referred to as “draw period”, may be set to avoid clinical drawbacks,and/or it can be varied according to a health-care provider's wishes.For example, in some embodiments, fluid may be continuously withdrawninto the sampling and analysis system 400 over a draw period lastingapproximately 10 seconds to approximately 5 minutes.

In some embodiments, the amount of sample withdrawn from the fluidsource 402 can be small. For example, in some embodiments, the volume ofsample withdrawn from the fluid source can be between approximately 1.0ml and approximately 10.0 ml in a draw period (e.g. 2.0 ml-6.0 ml ofsample can be withdrawn in a draw period of approximately 1 minute). Insome embodiments, the amount of sample withdrawn can be in the range ofapproximately 20 ml/day to approximately 500 ml/day. In someembodiments, the amount of sample withdrawn can be outside this range.

In some embodiments, at least a portion of the sample is returned to thefluid source 402. At least some of the sample, such as portions of thesample that are mixed with other materials or portions that areotherwise altered during the sampling and analysis process, or portionsthat, for any reason, are not to be returned to the fluid source 402,can also be placed in a waste bladder (not shown in FIG. 4). The wastebladder can be integrated into the fluid-handling system 404 or suppliedby a user of the system 400. The fluid-handling system 404 can also beconnected to a saline source, a detergent source, and/or ananticoagulant source, each of which can be supplied by a user, attachedto the fluid-handling system 404 as additional fluid sources, and/orintegrated into the fluid-handling system 404.

Components of the fluid-handling system 404 can be modularized into oneor more non-disposable, disposable, and/or replaceable subsystems. Inthe embodiment shown in FIG. 4, components of the fluid-handling system404 are separated into a non-disposable subsystem 406, a firstdisposable subsystem 408, and a second disposable sub system 410.

The non-disposable subsystem 406 can include components that, while theymay be replaceable or adjustable, do not generally require regularreplacement during the useful lifetime of the system 400. In someembodiments, the non-disposable subsystem 406 of the fluid-handlingsystem 404 includes one or more reusable valves and sensors. Forexample, the non-disposable subsystem 406 can include one or more valves(or non-disposable portions thereof), (e.g., pinch-valves, rotaryvalves, etc.), sensors (e.g., ultrasonic bubble sensors, non-contactpressure sensors, optical blood dilution sensors, etc). Thenon-disposable subsystem 406 can also include one or more pumps (ornon-disposable portions thereof). For example, some embodiments caninclude pumps available from Hospira. In some embodiments, thecomponents of the non-disposable subsystem 406 are not directly exposedto fluids and/or are not readily susceptible to contamination.

The first and second disposable subsystems 408, 410 can includecomponents that are regularly replaced under certain circumstances inorder to facilitate the operation of the system 400. For example, thefirst disposable subsystem 408 can be replaced after a certain period ofuse, such as a few days, has elapsed. Replacement may be necessary, forexample, when a bladder within the first disposable subsystem 408 isfilled to capacity. Such replacement may mitigate fluid systemperformance degradation associated with and/or contamination wear onsystem components.

In some embodiments, the first disposable subsystem 408 includescomponents that may contact fluids such as patient blood, saline,flushing solutions, anticoagulants, and/or detergent solutions. Forexample, the first disposable subsystem 408 can include one or moretubes, fittings, cleaner pouches and/or waste bladders. The componentsof the first disposable subsystem 408 can be sterilized in order todecrease the risk of infection and can be configured to be easilyreplaceable.

In some embodiments, the second disposable subsystem 410 can be designedto be replaced under certain circumstances. For example, the seconddisposable subsystem 410 can be replaced when the patient beingmonitored by the system 400 is changed. The components of the seconddisposable subsystem 410 may not need replacement at the same intervalsas the components of the first disposable subsystem 408. For example,the second disposable subsystem 410 can include a sample holder and/orat least some components of a centrifuge, components that may not becomefilled or quickly worn during operation of the system 400. Replacementof the second disposable subsystem 410 can decrease or eliminate therisk of transferring fluids from one patient to another during operationof the system 400, enhance the measurement performance of system 400,and/or reduce the risk of contamination or infection.

In some embodiments, the sample holder of the second disposablesubsystem 410 receives the sample obtained from the fluid source 402 viafluid passageways of the first disposable subsystem 408. The sampleholder is a container that can hold fluid for the centrifuge and caninclude a window to the sample for analysis by a spectrometer. In someembodiments, the sample holder includes windows that are made of amaterial that is substantially transparent to electromagnetic radiationin the mid-infrared range of the spectrum. For example, the sampleholder windows can be made of calcium fluoride.

An injector can provide a fluid connection between the first disposablesubsystem 408 and the sample holder of the second disposable subsystem410. In some embodiments, the injector can be removed from the sampleholder to allow for free spinning of the sample holder duringcentrifugation.

In some embodiments, the components of the sample are separated bycentrifuging for a period of time before measurements are performed bythe optical system 412. For example, a fluid sample (e.g., a bloodsample) can be centrifuged at a relatively high speed. The sample can bespun at a certain number of revolutions per minute (RPM) for a givenlength of time to separate blood plasma for spectral analysis. In someembodiments, the fluid sample is spun at about 7200 RPM. In someembodiments, the sample is spun at about 5000 RPM. In some embodiments,the fluid sample is spun at about 4500 RPM. In some embodiments, thefluid sample is spun at more than one rate for successive time periods.The length of time can be approximately 5 minutes. In some embodiments,the length of time is approximately 2 minutes. Separation of a sampleinto the components can permit measurement of solute (e.g., glucose)concentration in plasma, for example, without interference from otherblood components. This kind of post-separation measurement, (sometimesreferred to as a “direct measurement”) has advantages over a solutemeasurement taken from whole blood because the proportions of plasma toother components need not be known or estimated in order to infer plasmaglucose concentration. In some embodiments, the separated plasma can beanalyzed electrically using one or more electrodes instead of, or inaddition to, being analyzed optically. This analysis may occur withinthe same device, or within a different device. For example, in certainembodiments, an optical analysis device can separate blood intocomponents, analyze the components, and then allow the components to betransported to another analysis device that can further analyze thecomponents (e.g., using electrical and/or electrochemical measurements).

An anticoagulant, such as, for example, heparin can be added to thesample before centrifugation to prevent clotting. The fluid-handlingsystem 404 can be used with a variety of anticoagulants, includinganticoagulants supplied by a hospital or other user of the monitoringsystem 400. A detergent solution formed by mixing detergent powder froma pouch connected to the fluid-handling system 404 with saline can beused to periodically clean residual protein and other sample remnantsfrom one or more components of the fluid-handling system 404, such asthe sample holder. Sample fluid to which anticoagulant has been addedand used detergent solution can be transferred into the waste bladder.

The system 400 shown in FIG. 4 includes an optical system 412 that canmeasure optical properties (e.g., transmission) of a fluid sample (or aportion thereof). In some embodiments, the optical system 412 measurestransmission in the mid-infrared range of the spectrum. In someembodiments, the optical system 412 includes a spectrometer thatmeasures the transmission of broadband infrared light through a portionof a sample holder filled with fluid. The spectrometer need not comeinto direct contact with the sample. As used herein, the term “sampleholder” is a broad term that carries its ordinary meaning as an objectthat can provide a place for fluid. The fluid can enter the sampleholder by flowing.

In some embodiments, the optical system 412 includes a filter wheel thatcontains one or more filters. In some embodiments, more than ten filterscan be included, for example twelve or fifteen filters. In someembodiments, more than 20 filters (e.g., twenty-five filters) aremounted on the filter wheel. The optical system 412 includes a lightsource that passes light through a filter and the sample holder to adetector. In some embodiments, a stepper motor moves the filter wheel inorder to position a selected filter in the path of the light. An opticalencoder can also be used to finely position one or more filters. In someembodiments, one or more tunable filters may be used to filter lightinto multiple wavelengths. The one or more tunable filters may providethe multiple wavelengths of light at the same time or at different times(e.g., sequentially). The light source included in the optical system412 may emit radiation in the ultraviolet, visible, near-infrared,mid-infrared, and/or far-infrared regions of the electromagneticspectrum. In some embodiments, the light source can be a broadbandsource that emits radiation in a broad spectral region (e.g., from about1500 nm to about 6000 nm). In other embodiments, the light source mayemit radiation at certain specific wavelengths. The light source maycomprise one or more light emitting diodes (LEDs) emitting radiation atone or more wavelengths in the radiation regions described herein. Inother embodiments, the light source may comprise one or more lasermodules emitting radiation at one or more wavelengths. The laser modulesmay comprise a solid state laser (e.g., a Nd:YAG laser), a semiconductorbased laser (e.g., a GaAs and/or InGaAsP laser), and/or a gas laser(e.g., an Ar-ion laser). In some embodiments, the laser modules maycomprise a fiber laser. The laser modules may emit radiation at certainfixed wavelengths. In some embodiments, the emission wavelength of thelaser module(s) may be tunable over a wide spectral range (e.g., about30 nm to about 100 nm). In some embodiments, the light source includedin the optical system 412 may be a thermal infrared emitter. The lightsource can comprise a resistive heating element, which, in someembodiments, may be integrated on a thin dielectric membrane on amicromachined silicon structure. In one embodiment the light source isgenerally similar to the electrical modulated thermal infrared radiationsource, IRSource™, available from the Axetris Microsystems division ofLeister Technologies, LLC (Itasca, Ill.).

The optical system 412 can be controlled by an optical system controller413. The optical system controller can, in some embodiments, beintegrated into the optical system 412. In some embodiments, the fluidsystem controller 405 and the optical system controller 413 cancommunicate with each other as indicated by the line 411. In someembodiments, the function of these two controllers can be integrated anda single controller can control both the fluid-handling system 404 andthe optical system 412. Such an integrated control can be advantageousbecause the two systems are preferably integrated, and the opticalsystem 412 is preferably configured to analyze the very same fluidhandled by the fluid-handling system 404. Indeed, portions of thefluid-handling system 404 (e.g., the sample holder described above withrespect to the second disposable subsystem 410 and/or at least somecomponents of a centrifuge) can also be components of the optical system412. Accordingly, the fluid-handling system 404 can be controlled toobtain a fluid sample for analysis by optical system 412, when the fluidsample arrives, the optical system 412 can be controlled to analyze thesample, and when the analysis is complete (or before), thefluid-handling system 404 can be controlled to return some of the sampleto the fluid source 402 and/or discard some of the sample, asappropriate.

The system 400 shown in FIG. 4 includes a display system 414 thatprovides for communication of information to a user of the system 400.In some embodiments, the display 414 can be replaced by or supplementedwith other communication devices that communicate in non-visual ways.The display system 414 can include a display processor that controls orproduces an interface to communicate information to the user. Thedisplay system 414 can include a display screen. One or more parameterssuch as, for example, blood glucose concentration, system 400 operatingparameters, and/or other operating parameters can be displayed on amonitor (not shown) associated with the system 400. An example of oneway such information can be displayed is shown in FIGS. 24 and 25. Insome embodiments, the display system 414 can communicate measuredphysiological parameters and/or operating parameters to a computersystem over a communications connection.

The system 400 shown in FIG. 4 includes an algorithm processor 416 thatcan receive spectral information, such as optical density (OD) values(or other analog or digital optical data) from the optical system 412and or the optical system controller 413. In some embodiments, thealgorithm processor 416 calculates one or more physiological parametersand can analyze the spectral information. Thus, for example and withoutlimitation, a model can be used that determines, based on the spectralinformation, physiological parameters of fluid from the fluid source402. The algorithm processor 416, a controller that may be part of thedisplay system 414, and any embedded controllers within the system 400can be connected to one another with a communications bus.

Some embodiments of the systems described herein (e.g., the system 400),as well as some embodiments of each method described herein, can includea computer program accessible to and/or executable by a processingsystem, e.g., a one or more processors and memories that are part of anembedded system. Indeed, the controllers may comprise one or morecomputers and/or may use software. Thus, as will be appreciated by thoseskilled in the art, various embodiments may be embodied as a method, anapparatus such as a special purpose apparatus, an apparatus such as adata processing system, or a carrier medium, e.g., a computer programproduct. The carrier medium carries one or more computer readable codesegments for controlling a processing system to implement a method.Accordingly, various embodiments may take the form of a method, anentirely hardware embodiment, an entirely software embodiment or anembodiment combining software and hardware aspects. Furthermore, any oneor more of the disclosed methods (including but not limited to thedisclosed methods of measurement analysis, interferent determination,and/or calibration constant generation) may be stored as one or morecomputer readable code segments or data compilations on a carriermedium. Any suitable computer readable carrier medium may be usedincluding a magnetic storage device such as a diskette or a hard disk; amemory cartridge, module, card or chip (either alone or installed withina larger device); or an optical storage device such as a CD or DVD.

Fluid Handling System

The generalized fluid-handling system 404 can have variousconfigurations. In this context, FIG. 5 schematically illustrates thelayout of an example embodiment of a fluid system 510. In this schematicrepresentation, various components are depicted that may be part of anon-disposable subsystem 406, a first disposable subsystem 408, a seconddisposable subsystem 410, and/or an optical system 412. The fluid system510 is described practically to show an example cycle as fluid is drawnand analyzed.

In addition to the reference numerals used below, the various portionsof the illustrated fluid system 510 are labeled for convenience withletters to suggest their roles as follows: T# indicates a section oftubing. C# indicates a connector that joins multiple tubing sections. V#indicates a valve. BS# indicates a bubble sensor or ultrasonic airdetector. N# indicates a needle (e.g., a needle that injects sample intoa sample holder). PS# indicates a pressure sensor (e.g., a reusablepressure sensor). Pump# indicates a fluid pump (e.g., a syringe pumpwith a disposable body and reusable drive). “Hb 12” indicates a sensorfor hemoglobin (e.g., a dilution sensor that can detect hemoglobinoptically).

The term “valve” as used herein is a broad term and is used, inaccordance with its ordinary meaning, to refer to any flow regulatingdevice. For example, the term “valve” can include, without limitation,any device or system that can controllably allow, prevent, or inhibitthe flow of fluid through a fluid passageway. The term “valve” caninclude some or all of the following, alone or in combination: pinchvalves, rotary valves, stop cocks, pressure valves, shuttle valves,mechanical valves, electrical valves, electro-mechanical flowregulators, etc. In some embodiments, a valve can regulate flow usinggravitational methods or by applying electrical voltages or by both.

The term “pump” as used herein is a broad term and is used, inaccordance with its ordinary meaning, to refer to any device that canurge fluid flow. For example, the term “pump” can include anycombination of the following: syringe pumps, peristaltic pumps, vacuumpumps, electrical pumps, mechanical pumps, hydraulic pumps, etc. Pumpsand/or pump components that are suitable for use with some embodimentscan be obtained, for example, from or through Hospira.

The function of the valves, pumps, actuators, drivers, motors (e.g., thecentrifuge motor), etc. described below is controlled by one or morecontrollers (e.g., the fluid system controller 405, the optical systemcontroller 413, etc.) The controllers can include software, computermemory, electrical and mechanical connections to the controlledcomponents, etc.

At the start of a measurement cycle, most lines, including a patienttube 512 (T1), an Arrival sensor tube 528 (T4), an anticoagulant valvetube 534 (T3), and a sample cell 548 can be filled with saline that canbe introduced into the system through the infusion tube 514 and thesaline tube 516, and which can come from an infusion pump 518 and/or asaline bag 520. The infusion pump 518 and the saline bag 520 can beprovided separately from the system 510. For example, a hospital can useexisting saline bags and infusion pumps to interface with the describedsystem. The infusion valve 521 can be open to allow saline to flow intothe tube 512 (T1).

Before drawing a sample, the saline in part of the system 510 can bereplaced with air. Thus, for example, the following valves can beclosed: air valve 503 (PV0), the detergent tank valve 559 (V7 b), 566(V3 b), 523 (V0), 529 (V7 a), and 563 (V2 b). At the same time, thefollowing valves can be open: valves 531 (V1 a), 533 (V3 a) and 577 (V4a). Simultaneously, a second pump 532 (pump #0) pumps air through thesystem 510 (including tube 534 (T3), sample cell 548, and tube 556(T6)), pushing saline through tube 534 (T3) and sample cell 548 into awaste bladder 554.

Next, a sample can be drawn. With the valves 542 (PV1), 559 (V7 b), and561 (V4 b) closed, a first pump 522 (pump #1) is actuated to draw samplefluid to be analyzed (e.g. blood) from a fluid source (e.g., alaboratory sample container, a living patient, etc.) up into the patienttube 512 (T1), through the tube past the two flanking portions of theopen pinch-valve 523 (V0), through the first connector 524 (C1), intothe looped tube 530, past the arrival sensor 526 (Hb12), and into thearrival sensor tube 528 (T4). The arrival sensor 526 may be used todetect the presence of blood in the tube 528 (T4). For example in someembodiments, the arrival sensor 526 may comprise a hemoglobin sensor. Insome other embodiments, the arrival sensor 526 may comprise a colorsensor that detects the color of fluid flowing through the tube 528(T4). During this process, the valve 529 (V7 a) and 523 (V0) are open tofluid flow, and the valves 531 (V1 a), 533 (V3 a), 542 (PV1), 559 (V7b), and 561 (V4 b) can be closed and therefore block (or substantiallyblock) fluid flow by pinching the tube.

Before drawing the sample, the tubes 512 (T1) and 528 (T4) are filledwith saline and the hemoglobin (Hb) level is zero. The tubes that arefilled with saline are in fluid communication with the sample source(e.g., the fluid source 402). The sample source can be the vessels of aliving human or a pool of liquid in a laboratory sample container, forexample. When the saline is drawn toward the first pump 522, fluid to beanalyzed is also drawn into the system because of the suction forces inthe closed fluid system. Thus, the first pump 522 draws a relativelycontinuous column of fluid that first comprises generally nondilutedsaline, then a mixture of saline and sample fluid (e.g., blood), andthen eventually nondiluted sample fluid. In the example illustratedhere, the sample fluid is blood.

The arrival sensor 526 (Hb12) can detect and/or verify the presence ofblood in the tubes. For example, in some embodiments, the arrival sensor526 can determine the color of the fluid in the tubes. In someembodiments, the arrival sensor 526 (Hb12) can detect the level ofHemoglobin in the sample fluid. As blood starts to arrive at the arrivalsensor 526 (Hb12), the sensed hemoglobin level rises. A hemoglobin levelcan be selected, and the system can be pre-set to determine when thatlevel is reached. A controller such as the fluid system controller 405of FIG. 4 can be used to set and react to the pre-set value, forexample. In some embodiments, when the sensed hemoglobin level reachesthe pre-set value, substantially undiluted sample is present at thefirst connector 524 (C1). The preset value can depend, in part, on thelength and diameter of any tubes and/or passages traversed by thesample. In some embodiments, the pre-set value can be reached afterapproximately 2 mL of fluid (e.g., blood) has been drawn from a fluidsource. A nondiluted sample can be, for example, a blood sample that isnot diluted with saline solution, but instead has the characteristics ofthe rest of the blood flowing through a patient's body. A loop of tubing530 (e.g., a 1-mL loop) can be advantageously positioned as illustratedto help insure that undiluted fluid (e.g., undiluted blood) is presentat the first connector 524 (C1) when the arrival sensor 526 registersthat the preset Hb threshold is crossed. The loop of tubing 530 providesadditional length to the Arrival sensor tube 528 (T4) to make it lesslikely that the portion of the fluid column in the tubing at the firstconnector 524 (C1) has advanced all the way past the mixture of salineand sample fluid, and the nondiluted blood portion of that fluid hasreached the first connector 524 (C1).

In some embodiments, when nondiluted blood is present at the firstconnector 524 (C1), a sample is mixed with an anticoagulant and isdirected toward the sample cell 548. An amount of anticoagulant (e.g.,heparin) can be introduced into the tube 534 (T3), and then theundiluted blood is mixed with the anticoagulant. A heparin vial 538(e.g., an insertable vial provided independently by the user of thesystem 510) can be connected to a tube 540. An anticoagulant valve 541(which can be a shuttle valve, for example) can be configured to connectto both the tube 540 and the anticoagulant valve tube 534 (T3). Thevalve can open the tube 540 to a suction force (e.g., created by thepump 532), allowing heparin to be drawn from the vial 538 into the valve541. Then, the anticoagulant valve 541 can slide the heparin over intofluid communication with the anticoagulant valve tube 534 (T3). Theanticoagulant valve 541 can then return to its previous position. Thus,heparin can be shuttled from the tube 540 into the anticoagulant valvetube 534 (T3) to provide a controlled amount of heparin into the tube534 (T3).

With the valves 542 (PV1), 559 (V7 b), 561 (V4 b), 523 (V0), 531 (V1 a),566 (V3 b), and 563 (V2 b) closed, and the valves 529 (V7 a) and 533 (V3a) open, first pump 522 (pump #1) pushes the sample from tube 528 (T4)into tube 534 (T3), where the sample mixes with the heparin injected bythe anticoagulant valve 541 as it flows through the system 510. As thesample proceeds through the tube 534 (T3), the air that was previouslyintroduced into the tube 534 (T3) is displaced. The sample continues toflow until a bubble sensor 535 (BS9) indicates a change from air to aliquid, and thus the arrival of a sample at the bubble sensor. In someembodiments, the volume of tube 534 (T3) from connector 524 (C1) tobubble sensor 535 (BS9) is a known and/or engineered amount, and may beapproximately 500 μL, 200 μL or 100 μL, for example. In someembodiments, the volume of tube 534 (T3) from connector 524 (C1) tobubble sensor 535 (BS9) may be approximately less than 10 ml.

When bubble sensor 535 (BS9) indicates the presence of a sample, theremainder of the sampled blood can be returned to its source (e.g., thepatient veins or arteries). The first pump 522 (pump #1) pushes theblood out of the Arrival sensor tube 528 (T4) and back to the patient byopening the valve 523 (V0), closing the valves 531 (V1 a) and 533 (V3a), and keeping the valve 529 (V7 a) open. The Arrival sensor tube 528(T4) is preferably flushed with approximately 2 mL of saline. This canbe accomplished by closing the valve 529 (V7 a), opening the valve 542(PV1), drawing saline from the saline source 520 into the tube 544,closing the valve 542 (PV1), opening the valve 529 (V7 a), and forcingthe saline down the Arrival sensor tube 528 (T4) with the pump 522. Insome embodiments, less than two minutes elapse between the time thatblood is drawn from the patient and the time that the blood is returnedto the patient.

Following return of the unused patient blood sample, the sample ispushed up the anticoagulant valve tube 534 (T3), through the secondconnector 546 (C2), and into the sample cell 548, which can be locatedon the centrifuge rotor 550. This fluid movement is facilitated by thecoordinated action (either pushing or drawing fluid) of the pump 522(pump #1), the pump 532 (pump #0), and the various illustrated valves.In particular, valve 531 (V1 a) can be opened, and valves 503 (PV0) and559 (V7 b) can be closed. Pump movement and valve position correspondingto each stage of fluid movement can be coordinated by one ore multiplecontrollers, such as the fluid system controller 405 of FIG. 4.

After the unused sample is returned to the patient, the sample can bedivided into separate slugs before being delivered into the sample cell548. Thus, for example, valve 533 (V3 a) is opened, valves 566 (V3 b),523 (V0) and 529 (V7 a) are closed, and the pump 532 (pump #0) uses airto push the sample toward sample cell 548. In some embodiments, thesample (for example, 200 μL or 100 μL) is divided into multiple (e.g.,more than two, five, or four) “slugs” of sample, each separated by asmall amount of air. As used herein, the term “slug” refers to acontinuous column of fluid that can be relatively short. Slugs can beseparated from one another by small amounts of air (or bubbles) that canbe present at intervals in the tube. In some embodiments, the slugs areformed by injecting or drawing air into fluid in the first connector 546(C2).

In some embodiments, when the leading edge of the sample reaches bloodsensor 552 (BS14), a small amount of air (the first “bubble”) isinjected at a connector C6. This bubble helps define the first “slug” ofliquid, which extends from the bubble sensor to the first bubble. Insome embodiments, the valves 533 (V3 a) and 566 (V3 b) are alternatelyopened and closed to form a bubble at connector C6, and the sample ispushed toward the sample cell 548. Thus, for example, with pump 532actuated, valve 566 V(3 b) is briefly opened and valve 533 (V3 a) isbriefly closed to inject a first air bubble into the sample.

In some embodiments, the volume of the tube 534 (T3) from the connector546 (C2) to the bubble sensor 552 (BS14) is less than the volume of tube534 (T3) from the connector 524 (C1) to the bubble sensor 535 (BS9).Thus, for example and without limitation, the volume of the tube 534(T3) from the connector 524 (C1) to the bubble sensor 535 (BS9) can bein the range of approximately 80 μL to approximately 120 μL, (e.g., 100μL,) and the volume of the tube 534 (T3) from the connector 546 (C2) tothe bubble sensor 552 (BS14) can be in the range of approximately 5 μLto approximately 25 μL (e.g., 15 μL). In some embodiments, multipleblood slugs are created. For example, more than two blood slugs can becreated, each having a different volume. In some embodiments, five bloodslugs are created, each having approximately the same volume ofapproximately 20 μL each. In some embodiments, three blood slugs arecreated, the first two having a volume of 10 μL and the last having avolume of 20 μL. In some embodiments, four blood slugs are created; thefirst three blood slugs can have a volume of approximately 15 μL, andthe fourth can have a volume of approximately 35 μL.

A second slug can be prepared by opening the valve 533 (V3 a), closingthe valve 566 (V3 b), with pump 532 (pump #0) operating to push thefirst slug through a first sample cell holder interface tube 582 (N1),through the sample cell 548, through a second sample cell holderinterface tube 584 (N2), and toward the waste bladder 554. When thefirst bubble reaches the bubble sensor 552 (BS 14), the open/closedconfigurations of valves 533 (V3 a) and 566 (V3 b) are reversed, and asecond bubble is injected into the sample, as before. A third slug canbe prepared in the same manner as the second (pushing the second bubbleto bubble sensor 552 (BS 14) and injecting a third bubble). After theinjection of the third air bubble, the sample can be pushed throughsystem 510 until the end of the sample is detected by bubble sensor 552(BS 14). The system can be designed such that when the end of the samplereaches this point, the last portion of the sample (a fourth slug) iswithin the sample cell 548, and the pump 532 can stop forcing the fluidcolumn through the anticoagulant valve tube 534 (T3) so that the fourthslug remains within the sample cell 548. Thus, the first three bloodslugs can serve to flush any residual saline out the sample cell 548.The three leading slugs can be deposited in the waste bladder 554 bypassing through the tube 556 (T6) and past the tube-flanking portions ofthe open pinch valve 557 (V4 a).

In some embodiments, the fourth blood slug is centrifuged for a givenlength of time (e.g., more than 1 minute, five minutes, or 2 minutes, totake three advantageous examples) at a relatively fast speed (e.g., 7200RPM, 5000 RPM, or 4500 RPM, to take three examples). Thus, for example,the sample cell holder interface tubes 582 (N1) and 584 (N2) disconnectthe sample cell 548 from the tubes 534 (T3) and 562 (T7), permitting thecentrifuge rotor 550 and the sample cell 548 to spin together. Spinningseparates a sample (e.g., blood) into its components, isolates theplasma, and positions the plasma in the sample cell 548 for measurement.The centrifuge 550 can be stopped with the sample cell 548 in a beam ofradiation (not shown) for analysis. The radiation, a detector, and logiccan be used to analyze a portion of the sample (e.g., the plasma)spectroscopically (e.g., for glucose, lactate, or other analyteconcentration). In some embodiments, some or all of the separatedcomponents (e.g., the isolated plasma) may be transported to a differentanalysis chamber. For example, another analysis chamber can have one ormore electrodes in electrical communication with the chamber's contents,and the separated components may be analyzed electrically. At anysuitable point, one or more of the separated components can betransported to the waste bladder 554 when no longer needed. In somechemical analysis systems and apparatus, the separated components areanalyzed electrically. Analysis devices may be connected serially, forexample, so that the analyzed substance from an optical analysis system(e.g., an “OptiScanner®” fluid analyzer) can be transferred to anindependent analysis device (e.g., a chemical analysis device) forsubsequent analysis. In certain embodiments, the analysis devices areintegrated into a single system. Many variations are possible.

In some embodiments, portions of the system 510 that contain blood afterthe sample cell 548 has been provided with a sample are cleaned toprevent blood from clotting. Accordingly, the centrifuge rotor 550 caninclude two passageways for fluid that may be connected to the samplecell holder interface tubes 582 (N1) and 584 (N2). One passageway issample cell 548, and a second passageway is a shunt 586. An embodimentof the shunt 586 is illustrated in more detail in FIG. 16 (see referencenumeral 1586).

The shunt 586 can allow cleaner (e.g., a detergent such as tergazyme A)to flow through and clean the sample cell holder interface tubes withoutflowing through the sample cell 548. After the sample cell 548 isprovided with a sample, the interface tubes 582 (N1) and 584 (N2) aredisconnected from the sample cell 548, the centrifuge rotor 550 isrotated to align the shunt 586 with the interface tubes 582 (N1) and 584(N2), and the interface tubes are connected with the shunt. With theshunt in place, the detergent tank 559 is pressurized by the second pump532 (pump #0) with valves 561 (V4 b) and 563 (V2 b) open and valves 557(V4 a) and 533 (V3 a) closed to flush the cleaning solution back throughthe interface tubes 582 (N1) and 584 (N2) and into the waste bladder554. Subsequently, saline can be drawn from the saline bag 520 for asaline flush. This flush pushes saline through the Arrival sensor tube528 (T4), the anticoagulant valve tube 534 (T3), the sample cell 548,and the waste tube 556 (T6). Thus, in some embodiments, the followingvalves are open for this flush: 529 (V7 a), 533 (V3 a), 557 (V4 a), andthe following valves are closed: 542 (PV1), 523 (V0), 531 (V1 a), 566(V3 b), 563 (V2 b), and 561 (V4 b).

Following analysis, the second pump 532 (pump #0) flushes the samplecell 548 and sends the flushed contents to the waste bladder 554. Thisflush can be done with a cleaning solution from the detergent tank 558.In some embodiments, the detergent tank valve 559 (V7 b) is open,providing fluid communication between the second pump 532 and thedetergent tank 558. The second pump 532 forces cleaning solution fromthe detergent tank 558 between the tube-flanking portions of the openpinch valve 561 and through the tube 562 (T7). The cleaning flush canpass through the sample cell 548, through the second connector 546,through the tube 564 (T5) and the open valve 563 (V2 b), and into thewaste bladder 554.

Subsequently, the first pump 522 (pump #1) can flush the cleaningsolution out of the sample cell 548 using saline in drawn from thesaline bag 520. This flush pushes saline through the Arrival sensor tube528 (T4), the anticoagulant valve tube 534 (T3), the sample cell 548,and the waste tube 556 (T6). Thus, in some embodiments, the followingvalves are open for this flush: 529 (V7 a), 533 (V3 a), 557 (V4 a), andthe following valves are closed: 542 (PV1), 523 (V0), 531 (V1 a), 566(V3 b), 563 (V2 b), and 561 (V4 b).

When the fluid source is a living entity such as a patient, a low flowof saline (e.g., 1-5 mL/hr) is preferably moved through the patient tube512 (T1) and into the patient to keep the patient's vessel open (e.g.,to establish a keep vessel open, or “KVO” flow). This KVO flow can betemporarily interrupted when fluid is drawn into the fluid system 510.The source of this KVO flow can be the infusion pump 518, the third pump568 (pump #3), or the first pump 522 (pump #1). In some embodiments, theinfusion pump 518 can run continuously throughout the measurement cycledescribed above. This continuous flow can advantageously avoid anyalarms that may be triggered if the infusion pump 518 senses that theflow has stopped or changed in some other way. In some embodiments, whenthe infusion valve 521 closes to allow pump 522 (pump #1) to withdrawfluid from a fluid source (e.g., a patient), the third pump 568 (pump#3) can withdraw fluid through the connector 570, thus allowing theinfusion pump 518 to continue pumping normally as if the fluid path wasnot blocked by the infusion valve 521. If the measurement cycle is abouttwo minutes long, this withdrawal by the third pump 568 can continue forapproximately two minutes. Once the infusion valve 521 is open again,the third pump 568 (pump #3) can reverse and insert the saline back intothe system at a low flow rate. Preferably, the time between measurementcycles is longer than the measurement cycle itself (for example, thetime interval can be longer than ten minutes, shorter than ten minutes,shorter than five minutes, longer than two minutes, longer than oneminute, etc.). Accordingly, the third pump 568 can insert fluid backinto the system at a lower rate than it withdrew that fluid. This canhelp prevent an alarm by the infusion pump.

FIG. 6 schematically illustrates another embodiment of a fluid systemthat can be part of a system for withdrawing and analyzing fluidsamples. In this embodiment, the anticoagulant valve 541 has beenreplaced with a syringe-style pump 588 (Pump Heparin) and a series ofpinch valves around a junction between tubes. For example, a heparinpinch valve 589 (Vhep) can be closed to prevent flow from or to the pump588, and a heparin waste pinch valve 590 can be closed to prevent flowfrom or to the waste container from this junction through the heparinwaste tube 591. This embodiment also illustrates the shunt 592schematically. Other differences from FIG. 5 include the check valve 593located near the detergent tank 558 and the patient loop 594. Thereference letters D, for example, the one indicated at 595, refer tocomponents that are advantageously located on the door. The referenceletters M, for example, the one indicated at 596, refer to componentsthat are advantageously located on the monitor. The reference letters B,for example, the one indicated at 597, refer to components that can beadvantageously located on both the door and the monitor.

In some embodiments, the system 400 (see FIG. 4), the apparatus 100 (seeFIG. 1), or even the monitoring device 102 (see FIG. 1) itself can alsoactively function not only to monitor analyte levels (e.g., glucose),but also to change and/or control analyte levels. Thus, the monitoringdevice 102 can be both a monitoring and an infusing device. In someembodiments, the fluid handling system 510 can include an optionalanalyte control subsystem 2780 that will be further described below (seediscussion of analyte control).

In certain embodiments, analyte levels in a patient can be adjusteddirectly (e.g., by infusing or extracting glucose) or indirectly (e.g.,by infusing or extracting insulin). FIG. 6 illustrates one way ofproviding this function. The infusion pinch valve 598 (V8) can allow theport sharing pump 599 (compare to the third pump 568 (pump #3) in FIG.5) to serve two roles. In the first role, it can serve as a “portsharing” pump. The port sharing function is described with respect tothe third pump 568 (pump #3) of FIG. 5, where the third pump 568 (pump#3) can withdraw fluid through the connector 570, thus allowing theinfusion pump 518 to continue pumping normally as if the fluid path wasnot blocked by the infusion valve 521. In the second role, the portsharing pump 599 can serve as an infusion pump. The infusion pump roleallows the port sharing pump 599 to draw a substance (e.g., glucose,saline, etc.) from another source when the infusion pinch valve 598 isopen, and then to infuse that substance into the system or the patientwhen the infusion pinch valve 598 is closed. This can occur, forexample, in order to change the level of a substance in a patient inresponse to a reading by the monitor that the substance is too low. Insome embodiments, one or more of the pumps may comprise a reversibleinfusion pump configured to interrupt the flow of the infusion fluid anddraw a sample of blood for analysis.

Mechanical/Fluid System Interface

FIG. 7 is an oblique schematic depiction of a modular monitoring device700, which can correspond to the monitoring device 102. The modularmonitoring device 700 includes a body portion 702 having a receptacle704, which can be accessed by moving a movable portion 706. Thereceptacle 704 can include connectors (e.g., rails, slots, protrusions,resting surfaces, etc.) with which a removable portion 710 caninterface. In some embodiments, portions of a fluidic system thatdirectly contact fluid are incorporated into one or more removableportions (e.g., one or more disposable cassettes, sample holders, tubingcards, etc.). For example, a removable portion 710 can house at least aportion of the fluid system 510 described previously, including portionsthat contact sample fluids, saline, detergent solution, and/oranticoagulant.

In some embodiments, a non-disposable fluid-handling subsystem 708 isdisposed within the body portion 702 of the monitoring device 700. Thefirst removable portion 710 can include one or more openings that allowportions of the non-disposable fluid-handling subsystem 708 to interfacewith the removable portion 710. For example, the non-disposablefluid-handling subsystem 708 can include one or more pinch valves thatare designed to extend through such openings to engage one or moresections of tubing. When the first removable portion 710 is present in acorresponding first receptacle 704, actuation of the pinch valves canselectively close sections of tubing within the removable portion. Thenon-disposable fluid-handling subsystem 708 can also include one or moresensors that interface with connectors, tubing sections, or pumpslocated within the first removable portion 710. The non-disposablefluid-handling subsystem 708 can also include one or more actuators(e.g., motors) that can actuate moveable portions (e.g., the plunger ofa syringe) that may be located in the removable portion 710. A portionof the non-disposable fluid-handling subsystem 708 can be located on orin the moveable portion 706 (which can be a door having a slide or ahinge, a detachable face portion, etc.).

In the embodiment shown in FIG. 7, the monitoring device 700 includes anoptical system 714 disposed within the body portion 702. The opticalsystem 714 can include a light source and a detector that are adapted toperform measurements on fluids within a sample holder (not shown). Thelight source may comprise a fixed wavelength light source and/or atunable light source. The light source may comprise one or more sourcesincluding, for example, broadband sources, LEDs, and lasers. In someembodiments, the sample holder comprises a removable portion, which canbe associated with or disassociated from the removable portion 710. Thesample holder can include an optical window through which the opticalsystem 714 can emit radiation for measuring properties of a fluid in thesample holder. The optical system 714 can include other components suchas, for example, a power supply, a centrifuge motor, a filter wheel,and/or a beam splitter.

In some embodiments, the removable portion 710 and the sample holder areadapted to be in fluid communication with each other. For example, theremovable portion 710 can include a retractable injector that injectsfluids into a sample holder. In some embodiments, the sample holder cancomprise or be disposed in a second removable portion (not shown). Insome embodiments, the injector can be retracted to allow the centrifugeto rotate the sample holder freely.

The body portion 702 of the monitoring device 700 can also include oneor more connectors for an external battery (not shown). The externalbattery can serve as a backup emergency power source in the event that aprimary emergency power source such as, for example, an internal battery(not shown) is exhausted.

FIG. 7 shows an embodiment of a system having subcomponents illustratedschematically. By way of a more detailed (but nevertheless non-limiting)example, FIG. 8 and FIG. 9 show more details of the shape and physicalconfiguration of a sample embodiment.

FIG. 8 shows a cut-away side view of a monitoring device 800 (which cancorrespond, for example, to the device 102 shown in FIG. 1). The device800 includes a casing 802. The monitoring device 800 can have a fluidsystem. For example, the fluid system can have subsystems, and a portionor portions thereof can be disposable, as schematically depicted in FIG.4. As depicted in FIG. 8, the fluid system is generally located at theleft-hand portion of the casing 802, as indicated by the reference 801.The monitoring device 800 can also have an optical system. In theillustrated embodiment, the optical system is generally located in theupper portion of the casing 802, as indicated by the reference 803.Advantageously, however, the fluid system 801 and the optical system 803can both be integrated together such that fluid flows generally througha portion of the optical system 803, and such that radiation flowsgenerally through a portion of the fluid system 801.

Depicted in FIG. 8 are examples of ways in which components of thedevice 800 mounted within the casing 802 can interface with componentsof the device 800 that comprise disposable portions. Not all componentsof the device 800 are shown in FIG. 8. A disposable portion 804 having avariety of components is shown in the casing 802. In some embodiments,one or more actuators 808 housed within the casing 802, operate syringebodies 810 located within a disposable portion 804. The syringe bodies810 are connected to sections of tubing 816 that move fluid amongvarious components of the system. The movement of fluid is at leastpartially controlled by the action of one or more pinch valves 812positioned within the casing 802. The pinch valves 812 have arms 814that extend within the disposable portion 804. Movement of the arms 814can constrict a section of tubing 816.

In some embodiments, a sample cell holder 820 can engage a centrifugemotor 818 mounted within the casing 802 of the device 800. A filterwheel motor 822 disposed within the housing 802 rotates a filter wheel824, and in some embodiments, aligns one or more filters with an opticalpath. An optical path can originate at a source 826 within the housing802 that can be configured to emit a beam of radiation (e.g., infraredradiation, visible radiation, ultraviolet radiation, etc.) through thefilter and the sample cell holder 820 and to a detector 828. A detector828 can measure the optical density of the light when it reaches thedetector.

FIG. 9 shows a cut-away perspective view of an alternative embodiment ofa monitoring device 900. Many features similar to those illustrated inFIG. 8 are depicted in this illustration of an alternative embodiment. Afluid system 901 can be partially seen. The disposable portion 904 isshown in an operative position within the device. One of the actuators808 can be seen next to a syringe body 910 that is located within thedisposable portion 904. Some pinch valves 912 are shown next to afluid-handling portion of the disposable portion 904. In this figure, anoptical system 903 can also be partially seen. The sample holder 920 islocated underneath the centrifuge motor 918. The filter wheel motor 922is positioned near the radiation source 926, and the detector 928 isalso illustrated.

FIG. 10 illustrates two views of a cartridge 1000 that can interfacewith a fluid system such as the fluid system 510 of FIG. 5. Thecartridge 1000 can be configured for insertion into a receptacle of thedevice 800 of FIG. 8 and/or the device 900 shown in FIG. 9. In someembodiments, the cartridge 1000 can comprise a portion that isdisposable and a portion that is reusable. In some embodiments, thecartridge 1000 can be disposable. The cartridge 1000 can fill the roleof the removable portion 710 of FIG. 7, for example. In someembodiments, the cartridge 1000 can be used for a system having only onedisposable subsystem, making it a simple matter for a health careprovider to replace and/or track usage time of the disposable portion.In some embodiments, the cartridge 1000 includes one or more featuresthat facilitate insertion of the cartridge 1000 into a correspondingreceptacle. For example, the cartridge 1000 can be shaped so as topromote insertion of the cartridge 1000 in the correct orientation. Thecartridge 1000 can also include labeling or coloring affixed to orintegrated with the cartridge's exterior casing that help a handlerinsert the cartridge 1000 into a receptacle properly.

The cartridge 1000 can include one or more ports for connecting tomaterial sources or receptacles. Such ports can be provided to connectto, for example, a saline source, an infusion pump, a sample source,and/or a source of gas (e.g., air, nitrogen, etc.). The ports can beconnected to sections of tubing within the cartridge 1000. In someembodiments, the sections of tubing are opaque or covered so that fluidswithin the tubing cannot be seen, and in some embodiments, sections oftubing are transparent to allow interior contents (e.g., fluid) to beseen from outside.

The cartridge 1000 shown in FIG. 10 can include a sample injector 1006.The sample injector 1006 can be configured to inject at least a portionof a sample into a sample holder (see, e.g., the sample cell 548), whichcan also be incorporated into the cartridge 1000. The sample injector1006 can include, for example, the sample cell holder interface tubes582 (N1) and 584 (N2) of FIG. 5, embodiments of which are alsoillustrated in FIG. 15.

The housing of the cartridge 1000 can include a tubing portion 1008containing within it a card having one or more sections of tubing. Insome embodiments, the body of the cartridge 1000 includes one or moreapertures 1009 through which various components, such as, for example,pinch valves and sensors, can interface with the fluid-handling portioncontained in the cartridge 1000. The sections of tubing found in thetubing portion 1008 can be aligned with the apertures 1009 in order toimplement at least some of the functionality shown in the fluid system510 of FIG. 5.

The cartridge 1000 can include a pouch space (not shown) that cancomprise one or more components of the fluid system 510. For example,one or more pouches and/or bladders can be disposed in the pouch space(not shown). In some embodiments, a cleaner pouch and/or a waste bladdercan be housed in a pouch space. The waste bladder can be placed underthe cleaner pouch such that, as detergent is removed from the cleanerpouch, the waste bladder has more room to fill. The components placed inthe pouch space (not shown) can also be placed side-by-side or in anyother suitable configuration.

The cartridge 1000 can include one or more pumps 1016 that facilitatemovement of fluid within the fluid system 510. Each of the pump housings1016 can contain, for example, a syringe pump having a plunger. Theplunger can be configured to interface with an actuator outside thecartridge 1000. For example, a portion of the pump that interfaces withan actuator can be exposed to the exterior of the cartridge 1000 housingby one or more apertures 1018 in the housing.

The cartridge 1000 can have an optical interface portion 1030 that isconfigured to interface with (or comprise a portion of) an opticalsystem. In the illustrated embodiment, the optical interface portion1030 can pivot around a pivot structure 1032. The optical interfaceportion 1030 can house a sample holder (not shown) in a chamber that canallow the sample holder to rotate. The sample holder can be held by acentrifuge interface 1036 that can be configured to engage a centrifugemotor (not shown). When the cartridge 1000 is being inserted into asystem, the orientation of the optical interface portion 1030 can bedifferent than when it is functioning within the system.

In some embodiments, the cartridge 1000 is designed for single patientuse. The cartridge 1000 may also be disposable and/or designed forreplacement after a period of operation. For example, in someembodiments, if the cartridge 1000 is installed in a continuouslyoperating monitoring device that performs four measurements per hour,the waste bladder may become filled or the detergent in the cleanerpouch depleted after about three days. The cartridge 1000 can bereplaced before the detergent and waste bladder are exhausted. In someembodiments, a portion of the cartridge 1000 can be disposable whileanother portion of the cartridge 1000 is disposable, but lasts longerbefore being discarded. In some embodiments, a portion of the cartridge1000 may not be disposable at all. For example, a portion thereof may beconfigured to be cleaned thoroughly and reused for different patients.Various combinations of disposable and less- or non-disposable portionsare possible.

The cartridge 1000 can be configured for easy replacement. For example,in some embodiments, the cartridge 1000 is designed to have aninstallation time of only minutes. For example, the cartridge can bedesigned to be installed in less than about five minutes, or less thantwo minutes. During installation, various fluid lines contained in thecartridge 1000 can be primed by automatically filling the fluid lineswith saline. The saline can be mixed with detergent powder from thecleaner pouch in order to create a cleaning solution.

The cartridge 1000 can also be designed to have a relatively brief shutdown time. For example, the shut down process can be configured to takeless than about fifteen minutes, or less than about ten minutes, or lessthan about five minutes. The shut down process can include flushing thepatient line; sealing off the insulin pump connection, the saline sourceconnection, and the sample source connection; and taking other steps todecrease the risk that fluids within the used cartridge 1000 will leakafter disconnection from the monitoring device.

Some embodiments of the cartridge 1000 can comprise a flat package tofacilitate packaging, shipping, sterilizing, etc. Advantageously,however, some embodiments can further comprise a hinge or other pivotstructure. Thus, as illustrated, an optical interface portion 1030 canbe pivoted around a pivot structure 1032 to generally align with theother portions of the cartridge 1000. The cartridge can be provided to amedical provider sealed in a removable wrapper, for example.

In some embodiments, the cartridge 1000 is designed to fit withinstandard waste containers found in a hospital, such as a standardbiohazard container. For example, the cartridge 1000 can be less thanone foot long, less than one foot wide, and less than two inches thick.In some embodiments, the cartridge 1000 is designed to withstand asubstantial impact, such as that caused by hitting the ground after afour foot drop, without damage to the housing or internal components. Insome embodiments, the cartridge 1000 is designed to withstandsignificant clamping force applied to its casing. For example, thecartridge 1000 can be built to withstand five pounds per square inch offorce without damage. In some embodiments, the cartridge 1000 can bedesigned to be less sturdy and more biodegradable. In some embodiments,the cartridge 1000 can be formed and configured to withstand more orless than five pounds of force per square inch without damage. In someembodiments, the cartridge 1000 is non pyrogenic and/or latex free.

FIG. 11 illustrates an embodiment of a fluid-routing card 1038 that canbe part of the removable cartridge of FIG. 10. For example, thefluid-routing card 1038 can be located generally within the tubingportion 1008 of the cartridge 1000. The fluid-routing card 1038 cancontain various passages and/or tubes through which fluid can flow asdescribed with respect to FIG. 5 and/or FIG. 6, for example. Thus, theillustrated tube openings can be in fluid communication with thefollowing fluidic components, for example:

TABLE 1 tube openings and fluidic components Tube Opening ReferenceNumeral Can Be In Fluid Communication With 1142 third pump 568 (pump #3)1144 infusion pump 518 1146 Presx 1148 air pump 1150 Vent 1152 detergent(e.g., tergazyme) source or waste tube 1154 Presx 1156 detergent (e.g.,tergazyme) source or waste tube 1158 waste receptacle 1160 first pump522 (pump #1) (e.g., a saline pump) 1162 saline source or waste tube1164 anticoagulant (e.g., heparin) pump (see FIG. 6) and/or shuttlevalve 1166 detergent (e.g., tergazyme) source or waste tube 1167 Presx1168 Arrival sensor tube 528 (T4) 1169 tube 536 (T2) 1170 Arrival sensortube 528 (T4) 1171 Arrival sensor tube 528 (T4) 1172 anticoagulant(e.g., heparin) pump 1173 T17 (see FIG. 6) 1174 Sample cell holderinterface tube 582 (N1) 1176 anticoagulant valve tube 534 (T3) 1178Sample cell holder interface tube 584 (N2) 1180 T17 (see FIG. 6) 1182anticoagulant valve tube 534 (T3) 1184 Arrival sensor tube 528 (T4) 1186tube 536 (T2) 1188 anticoagulant valve tube 534 (T3) 1190 anticoagulantvalve tube 534 (T3)

The depicted fluid-routing card 1038 can have additional openings thatallow operative portions of actuators and/or valves to protrude throughthe fluid-routing card 1038 and interface with the tubes.

FIG. 12 illustrates how actuators, which can sandwich the fluid-routingcard 1038 between them, can interface with the fluid-routing card 1038of FIG. 11. Pinch valves 812 can have an actuator portion that protrudesaway from the fluid-routing card 1038 containing a motor. Each motor cancorrespond to a pinch platen 1202, which can be inserted into a pinchplaten receiving hole 1204. Similarly, sensors, such as a bubble sensor1206 can be inserted into receiving holes (e.g., the bubble sensorreceiving hole 1208). Movement of the pinch valves 812 can be detectedby the position sensors 1210.

FIG. 13 illustrates an actuator 808 that is connected to a correspondingsyringe body 810. The actuator 808 is an example of one of the actuators808 that is illustrated in FIG. 8 and in FIG. 9, and the syringe body810 is an example of one of the syringe bodies 810 that are visible inFIG. 8 and in FIG. 9. A ledge portion 1212 of the syringe body 810 canbe engaged (e.g., slid into) a corresponding receiving portion 1214 inthe actuator 808. In some embodiments, the receiving portion 1214 canslide outward to engage the stationary ledge portion 1212 after thedisposable cartridge 804 is in place. Similarly, a receiving tube 1222in the syringe plunger 1223 can be slide onto (or can receive) aprotruding portion 1224 of the actuator 808. The protruding portion 1224can slide along a track 1226 under the influence of a motor inside theactuator 808, thus actuating the syringe plunger 1223 and causing fluidto flow into or out of the syringe tip 1230.

FIG. 14 shows a rear perspective view of internal scaffolding 1231 andthe protruding bodies of some pinch valves 812. The internal scaffolding1231 can be formed from metal and can provide structural rigidity andsupport for other components. The scaffolding 1231 can have holes 1232into which screws can be screwed or other connectors can be inserted. Insome embodiments, a pair of sliding rails 1234 can allow relativemovement between portions of an analyzer. For example, a slidableportion 1236 (which can correspond to the movable portion 706, forexample) can be temporarily slid away from the scaffolding 1231 of amain unit in order to allow an insertable portion (e.g., the cartridge804) to be inserted.

FIG. 15 shows an underneath perspective view of the sample cell holder820, which is attached to the centrifuge interface 1036. The sample cellholder 820 can have an opposite side (see FIG. 17) that allows it toslide into a receiving portion of the centrifuge interface 1036. Thesample cell holder 820 can also have receiving nubs 1512A that provide apathway into a sample cell 1548 held by the sample cell holder 820.Receiving nubs 1512B can provide access to a shunt 1586 (see FIG. 16)inside the sample cell holder 820. The receiving nubs 1512A and 1512Bcan receive and or dock with fluid nipples 1514. The fluid nipples 1514can protrude at an angle from the sample injector 1006, which can inturn protrude from the cartridge 1000 (see FIG. 10). The tubes 1516shown protruding from the other end of the sample injector 1006 can bein fluid communication with the sample cell holder interface tubes 582(N1) and 584 (N2) (see FIG. 5 and FIG. 6), as well as 1074 and 1078 (seeFIG. 11).

FIG. 16 shows a plan view of the sample cell holder 820 with hiddenand/or non-surface portions illustrated using dashed lines. Thereceiving nubs 1512A communicate with passages 1550 inside the samplecell 1548 (which can correspond, for example to the sample cell 548 ofFIG. 5). The passages widen out into a wider portion 1552 thatcorresponds to a window 1556. The window 1556 and the wider portion 1552can be configured to house the sample when radiation is emitted along apathlength that is generally non-parallel to the sample cell 1548. Thewindow 1556 can allow calibration of the instrument with the sample cell1548 in place, even before a sample has arrived in the wider portion1552.

An opposite opening 1530 can provide an alternative optical pathwaybetween a radiation source and a radiation detector (e.g., the radiationsource 826 of FIG. 18) and may be used, for example, for obtaining acalibration measurement of the source and detector without anintervening window or sample. Thus, the opposite opening 1530 can belocated generally at the same radial distance from the axis of rotationas the window 1556.

The receiving nubs 1512B communicate with a shunt passage 1586 insidethe sample cell holder 820 (which can correspond, for example to theshunt 586 of FIG. 5).

Other features of the sample cell holder 820 can provide balancingproperties for even rotation of the sample cell holder 820. For example,the wide trough 1562 and the narrower trough 1564 can be sized orotherwise configured so that the weight and/or mass of the sample cellholder 820 is evenly distributed from left to right in the view of FIG.16, and/or from top to bottom in this view of FIG. 16.

FIG. 17 shows a top perspective view of the centrifuge interface 1036connected to the sample cell holder 820. The centrifuge interface 1036can have a bulkhead 1520 with a rounded slot 1522 into which anactuating portion of a centrifuge can be slid from the side. Thecentrifuge interface 1036 can thus be spun about an axis 1524, alongwith the sample cell holder 820, causing fluid (e.g., whole blood)within the sample cell 1548 to separate into concentric strata,according to relative density of the fluid components (e.g., plasma, redblood cells, buffy coat, etc.), within the sample cell 1548. The samplecell holder 820 can be transparent, or it can at least have transparentportions (e.g., the window 1556 and/or the opposite opening 1530)through which radiation can pass, and which can be aligned with anoptical pathway between a radiation source and a radiation detector(see, e.g., FIG. 20). In addition, a round opening 1530 throughcentrifuge rotor 1520 provides an optical pathway between the radiationsource and radiation detector and may be used, for example, forobtaining a calibration measurement of the source and detector withoutan intervening window or sample.

FIG. 18 shows a perspective view of an example optical system 803. Sucha system can be integrated with other systems as shown in FIG. 9, forexample. The optical system 803 can fill the role of the optical system412, and it can be integrated with and/or adjacent to a fluid system(e.g., the fluid-handling system 404 or the fluid system 801). Thesample cell holder 820 can be seen attached to the centrifuge interface1036, which is in turn connected to, and rotatable by the centrifugemotor 818. A filter wheel housing 1812 is attached to the filter wheelmotor 822 and encloses a filter wheel 1814. A protruding shaft assembly1816 can be connected to the filter wheel 1814. The filter wheel 1814can have multiple filters (see FIG. 19). The radiation source 826 isaligned to transmit radiation through a filter in the filter wheel 1814and then through a portion of the sample cell holder 820. Transmittedand/or reflected and/or scattered radiation can then be detected by aradiation detector.

FIG. 19 shows a view of the filter wheel 1814 when it is not locatedwithin the filter wheel housing 1812 of the optical system 803.Additional features of the protruding shaft assembly 1816 can be seen,along with multiple filters 1820. In some embodiments, the filters 1820can be removably and/or replaceably inserted into the filter wheel 1814.

Spectroscopic System

As described above with reference to FIG. 4, the system 400 comprisesthe optical system 412 for analysis of a fluid sample. In variousembodiments, the optical system 412 comprises one or more opticalcomponents including, for example, a spectrometer, a photometer, areflectometer, or any other suitable device for measuring opticalproperties of the fluid sample. The optical system 412 may perform oneor more optical measurements on the fluid sample including, for example,measurements of transmittance, absorbance, reflectance, scattering,and/or polarization. The optical measurements may be performed in one ormore wavelength ranges including, for example, infrared (IR) and/oroptical wavelengths. As described with reference to FIG. 4 (and furtherdescribed below), the measurements from the optical system 412 arecommunicated to the algorithm processor 416 for analysis. For example,In some embodiments the algorithm processor 416 computes concentrationof analyte(s) (and/or interferent(s)) of interest in the fluid sample.Analytes of interest include, e.g., glucose and lactate in whole bloodor blood plasma.

FIG. 20 schematically illustrates an embodiment of the optical system412 that comprises a spectroscopic analyzer 2010 adapted to measurespectra of a fluid sample such as, for example, blood or blood plasma.The analyzer 2010 comprises an energy source 2012 disposed along anoptical axis X of the analyzer 2010. When activated, the energy source2012 generates an electromagnetic energy beam E, which advances from theenergy source 2012 along the optical axis X In some embodiments, theenergy source 2012 comprises an infrared energy source, and the energybeam E comprises an infrared beam. In some embodiments, the infraredenergy beam E comprises a mid-infrared energy beam or a near-infraredenergy beam. In some embodiments, the energy beam E can include opticaland/or radio frequency wavelengths.

The energy source 2012 may comprise a broad-band and/or a narrow-bandsource of electromagnetic energy. In some embodiments, the energy source2012 comprises optical elements such as, e.g., filters, collimators,lenses, mirrors, etc., that are adapted to produce a desired energy beamE. For example, in some embodiments, the energy beam E is an infraredbeam in a wavelength range between about 2 μm and 20 μm. In someembodiments, the energy beam E comprises an infrared beam in awavelength range between about 4 μm and 10 μm. In the infraredwavelength range, water generally is the main contributor to the totalabsorption together with features from absorption of other bloodcomponents, particularly in the 6 μm-10 μm range. The 4 μm to 10 μmwavelength band has been found to be advantageous for determiningglucose concentration, because glucose has a strong absorption peakstructure from about 8.5 μm to 10 μm, whereas most other bloodcomponents have a relatively low and flat absorption spectrum in the 8.5μm to 10 μm range. Two exceptions are water and hemoglobin, which areinterferents in this range.

The energy beam E may be temporally modulated to provide increasedsignal-to-noise ratio (S/N) of the measurements provided by the analyzer2010 as further described below. For example, in some embodiments, thebeam E is modulated at a frequency of about 10 Hz or in a range fromabout 1 Hz to about 30 Hz. A suitable energy source 2012 may be anelectrically modulated thin-film thermoresistive element such as theHawkEye IR-50 available from Hawkeye Technologies of Milford, Conn.

As depicted in FIG. 20, the energy beam E propagates along the opticalaxis X and passes through an aperture 2014 and a filter 2015 therebyproviding a filtered energy beam E_(f). The aperture 2014 helpscollimate the energy beam E and can include one or more filters adaptedto reduce the filtering burden of the filter 2015. For example, theaperture 2014 may comprise a broadband filter that substantiallyattenuates beam energy outside a wavelength band between about 4 μm toabout 10 μm. The filter 2015 may comprise a narrow-band filter thatsubstantially attenuates beam energy having wavelengths outside of afilter passband (which may be tunable or user-selectable in someembodiments). The filter passband may be specified by a half-powerbandwidth (“HPBW”). In some embodiments, the filter 2015 may have anHPBW in a range from about 0.1 μm to about 2 μm, or 0.01 μm to about 1μm. In some embodiments, the bandwidths are in a range from about 0.2 μmto 0.5 μm, or 0.1 μm to 0.35 μm. Other filter bandwidths may be used.The filter 2015 may comprise a varying-passband filter, anelectronically tunable filter, a liquid crystal filter, an interferencefilter, and/or a gradient filter. In some embodiments, the filter 2015comprises one or a combination of a grating, a prism, a monochrometer, aFabry-Perot etalon, and/or a polarizer. Other optical elements may beutilized as well.

In the embodiment shown in FIG. 20, the analyzer 2010 comprises a filterwheel assembly 2021 configured to dispose one or more filters 2015 alongthe optical axis X The filter wheel assembly 2021 comprises a filterwheel 2018, a filter wheel motor 2016, and a position sensor 2020. Thefilter wheel 2018 may be substantially circular and have one or morefilters 2015 or other optical elements (e.g., apertures, gratings,polarizers, mirrors, etc.) disposed around the circumference of thewheel 2018. In some embodiments, the number of filters 2015 in thefilter wheel 2016 may be, for example, 1, 2, 5, 10, 15, 20, 25, or more.The motor 2016 is configured to rotate the filter wheel 2018 to disposea desired filter 2015 (or other optical element) in the energy beam E soas to produce the filtered beam E_(f). In some embodiments, the motor2016 comprises a stepper motor. The position sensor 2020 determines theangular position of the filter wheel 2016, and communicates acorresponding filter wheel position signal to the algorithm processor416, thereby indicating which filter 2015 is in position on the opticalaxis X. In various embodiments, the position sensor 2020 may be amechanical, optical, and/or magnetic encoder. An alternative to thefilter wheel 2018 is a linear filter translated by a motor. The linearfilter can include an array of separate filters or a single filter withproperties that change along a linear dimension.

The filter wheel motor 2016 rotates the filter wheel 2018 to positionthe filters 2015 in the energy beam E to sequentially vary thewavelengths or the wavelength bands used to analyze the fluid sample. Insome embodiments, each individual filter 2015 is disposed in the energybeam E for a dwell time during which optical properties in the passbandof the filter are measured for the sample. The filter wheel motor 2016then rotates the filter wheel 2018 to position another filter 2015 inthe beam E. In some embodiments, 25 narrow-band filters are used in thefilter wheel 2018, and the dwell time is about 2 seconds for each filter2015. A set of optical measurements for all the filters can be taken inabout 2 minutes, including sampling time and filter wheel movement. Insome embodiments, the dwell time may be different for different filters2015, for example, to provide a substantially similar S/N ratio for eachfilter measurement. Accordingly, the filter wheel assembly 2021functions as a varying-passband filter that allows optical properties ofthe sample to be analyzed at a number of wavelengths or wavelength bandsin a sequential manner.

In some embodiments of the analyzer 2010, the filter wheel 2018 includes25 finite-bandwidth infrared filters having a Gaussian transmissionprofile and full-width half-maximum (FWHM) bandwidth of 28 cm⁻¹corresponding to a bandwidth that varies from 0.14 μm at 7.08 μm to 0.28μm at 10 μm. The central wavelength of the filters are, in microns:7.082, 7.158, 7.241, 7.331, 7.424, 7.513, 7.605, 7.704, 7.800, 7.905,8.019, 8.150, 8.271, 8.598, 8.718, 8.834, 8.969, 9.099, 9.217, 9.346,9.461, 9.579, 9.718, 9.862, and 9.990.

With further reference to FIG. 20, the filtered energy beam E_(f)propagates to a beamsplitter 2022 disposed along the optical axis X. Thebeamsplitter 2022 separates the filtered energy beam E_(f) into a samplebeam E_(s) and a reference beam E_(r). The reference beam E_(r)propagates along a minor optical axis Y, which in this embodiment issubstantially orthogonal to the optical axis X. The energies in thesample beam E_(s) and the reference beam E_(r) may comprise any suitablefraction of the energy in the filtered beam E_(f). For example, in someembodiments, the sample beam E_(s) comprises about 80%, and thereference beam Er comprises about 20%, of the filtered beam energyE_(f). A reference detector 2036 is positioned along the minor opticalaxis Y. An optical element 2034, such as a lens, may be used to focus orcollimate the reference beam E_(r) onto the reference detector 2036. Thereference detector 2036 provides a reference signal, which can be usedto monitor fluctuations in the intensity of the energy beam E emitted bythe source 2012. Such fluctuations may be due to drift effects, aging,wear, or other imperfections in the source 2012. The algorithm processor416 may utilize the reference signal to identify changes in propertiesof the sample beam E_(s) that are attributable to changes in theemission from the source 2012 and not to the properties of the fluidsample. By so doing, the analyzer 2010 may advantageously reducepossible sources of error in the calculated properties of the fluidsample (e.g., concentration). In other embodiments of the analyzer 2010,the beamsplitter 2022 is not used, and substantially all of the filteredenergy beam E_(f) propagates to the fluid sample.

As illustrated in FIG. 20, the sample beam E_(s) propagates along theoptical axis X, and a relay lens 2024 transmits the sample beam E_(s)into a sample cell 2048 so that at least a fraction of the sample beamE_(s) is transmitted through at least a portion of the fluid sample inthe sample cell 2048. A sample detector 2030 is positioned along theoptical axis X to measure the sample beam E_(s) that has passed throughthe portion of the fluid sample. An optical element 2028, such as alens, may be used to focus or collimate the sample beam E_(s) onto thesample detector 2030. The sample detector 2030 provides a sample signalthat can be used by the algorithm processor 416 as part of the sampleanalysis.

In the embodiment of the analyzer 2010 shown in FIG. 20, the sample cell2048 is located toward the outer circumference of the centrifuge wheel2050 (which can correspond, for example, to the sample cell holder 820described herein). The sample cell 2048 preferably comprises windowsthat are substantially transmissive to energy in the sample beam E_(s).For example, in implementations using mid-infrared energy, the windowsmay comprise calcium fluoride. As described herein with reference toFIG. 5, the sample cell 2048 is in fluid communication with an injectorsystem that permits filling the sample cell 2048 with a fluid sample(e.g., whole blood) and flushing the sample cell 2048 (e.g., with salineor a detergent). The injector system may disconnect after filling thesample cell 2048 with the fluid sample to permit free spinning of thecentrifuge wheel 2050.

The centrifuge wheel 2050 can be spun by a centrifuge motor 2026. Insome embodiments of the analyzer 2010, the fluid sample (e.g., a wholeblood sample) is spun at a certain number of revolutions per minute(RPM) for a given length of time to separate blood plasma for spectralanalysis. In some embodiments, the fluid sample is spun at about 7200RPM. In some embodiments, the fluid sample is spun at about 5000 RPM or4500 RPM. In some embodiments, the fluid sample is spun at more than onerate for successive time periods. The length of time can beapproximately 5 minutes. In some embodiments, the length of time isapproximately 2 minutes. In some embodiments, an anti-clotting agentsuch as heparin may be added to the fluid sample before centrifuging toreduce clotting. With reference to FIG. 20, the centrifuge wheel 2050 isrotated to a position where the sample cell 2048 intercepts the samplebeam E_(s), allowing energy to pass through the sample cell 2048 to thesample detector 2030.

The embodiment of the analyzer 2010 illustrated in FIG. 20advantageously permits direct measurement of the concentration ofanalytes in the plasma sample rather than by inference of theconcentration from measurements of a whole blood sample. An additionaladvantage is that relatively small volumes of fluid may bespectroscopically analyzed. For example, in some embodiments the fluidsample volume is between about 1 μL and 80 μL and is about 25 μL in someembodiments. In some embodiments, the sample cell 2048 is disposable andis intended for use with a single patient or for a single measurement.

In some embodiments, the reference detector 2036 and the sample detector2030 comprise broadband pyroelectric detectors. As known in the art,some pyroelectric detectors are sensitive to vibrations. Thus, forexample, the output of a pyroelectric infrared detector is the sum ofthe exposure to infrared radiation and to vibrations of the detector.The sensitivity to vibrations, also known as “microphonics,” canintroduce a noise component to the measurement of the reference andsample energy beams E_(r), E_(s) using some pyroelectric infrareddetectors. Because it may be desirable for the analyzer 2010 to providehigh signal-to-noise ratio measurements, such as, e.g., S/N in excess of100 dB, some embodiments of the analyzer 2010 utilize one or morevibrational noise reduction apparatus or methods. For example, theanalyzer 2010 may be mechanically isolated so that high S/Nspectroscopic measurements can be obtained for vibrations below anacceleration of about 1.5 G.

In some embodiments of the analyzer 2010, vibrational noise can bereduced by using a temporally modulated energy source 2012 combined withan output filter. In some embodiments, the energy source 2012 ismodulated at a known source frequency, and measurements made by thedetectors 2036 and 2030 are filtered using a narrowband filter centeredat the source frequency. For example, in some embodiments, the energyoutput of the source 2012 is sinusoidally modulated at 10 Hz, andoutputs of the detectors 2036 and 2030 are filtered using a narrowbandpass filter of less than about 1 Hz centered at 10 Hz. Accordingly,microphonic signals that are not at 10 Hz are significantly attenuated.In some embodiments, the modulation depth of the energy beam E may begreater than 50% such as, for example, 80%. The duty cycle of the beammay be between about 30% and 70%. The temporal modulation may besinusoidal or any other waveform. In embodiments utilizing temporallymodulated energy sources, detector output may be filtered using asynchronous demodulator and digital filter. The demodulator and filterare software components that may be digitally implemented in a processorsuch as the algorithm processor 416. Synchronous demodulators, coupledwith low pass filters, are often referred to as “lock in amplifiers.”

The analyzer 2010 may also include a vibration sensor 2032 (e.g., one ormore accelerometers) disposed near one (or both) of the detectors 2036and 2030. The output of the vibration sensor 2032 is monitored, andsuitable actions are taken if the measured vibration exceeds a vibrationthreshold. For example, in some embodiments, if the vibration sensor2032 detects above-threshold vibrations, the system discards any ongoingmeasurement and “holds off” on performing further measurements until thevibrations drop below the threshold. Discarded measurements may berepeated after the vibrations drop below the vibration threshold. Insome embodiments, if the duration of the “hold off” is sufficientlylong, the fluid in the sample cell 2030 is flushed, and a new fluidsample is delivered to the cell 2030 for measurement. The vibrationthreshold may be selected so that the error in analyte measurement is atan acceptable level for vibrations below the threshold. In someembodiments, the threshold corresponds to an error in glucoseconcentration of 5 mg/dL. The vibration threshold may be determinedindividually for each filter 2015.

Certain embodiments of the analyzer 2010 include a temperature system(not shown in FIG. 20) for monitoring and/or regulating the temperatureof system components (such as the detectors 2036, 2030) and/or the fluidsample. Such a temperature system can include temperature sensors,thermoelectrical heat pumps (e.g., a Peltier device), and/orthermistors, as well as a control system for monitoring and/orregulating temperature. In some embodiments, the control systemcomprises a proportional-plus-integral-plus-derivative (PID) control.For example, in some embodiments, the temperature system is used toregulate the temperature of the detectors 2030, 2036 to a desiredoperating temperature, such as 35 degrees Celsius.

Optical Measurement

The analyzer 2010 illustrated in FIG. 20 can be used to determineoptical properties of a substance in the sample cell 2048. The substancecan include whole blood, plasma, saline, water, air or other substances.In some embodiments, the optical properties include measurements of anabsorbance, transmittance, and/or optical density in the wavelengthpassbands of some or all of the filters 2015 disposed in the filterwheel 2018. As described above, a measurement cycle comprises disposingone or more filters 2015 in the energy beam E for a dwell time andmeasuring a reference signal with the reference detector 2036 and asample signal with the sample detector 2030. The number of filters 2015used in the measurement cycle will be denoted by N, and each filter 2015passes energy in a passband around a center wavelength λ_(i), where i isan index ranging over the number of filters (e.g., from 1 to N). The setof optical measurements from the sample detector 2036 in the passbandsof the N filters 2015 provide a wavelength-dependent spectrum of thesubstance in the sample cell 2048. The spectrum will be denoted byC_(s)(λ_(i)), where C_(s) may be a transmittance, absorbance, opticaldensity, or some other measure of an optical property of the substance.In some embodiments, the spectrum is normalized with respect to one ormore of the reference signals measured by the reference detector 2030and/or with respect to spectra of a reference substance (e.g., air orsaline). The measured spectra are communicated to the algorithmprocessor 416 for calculation of the concentration of the analyte(s) ofinterest in the fluid sample.

In some embodiments, the analyzer 2010 performs spectroscopicmeasurements on the fluid sample (known as a “wet” reading) and on oneor more reference samples. For example, an “air” reading occurs when thesample detector 2036 measures the sample signal without the sample cell2048 in place along the optical axis X. (This can occur, for example,when the opposite opening 1530 is aligned with the optical axis X). A“water” or “saline” reading occurs when the sample cell 2048 is filledwith water or saline, respectively. The algorithm processor 416 may beprogrammed to calculate analyte concentration using a combination ofthese spectral measurements.

In some embodiments, a pathlength corrected spectrum is calculated usingwet, air, and reference readings. For example, the transmittance atwavelength λ_(i), denoted by T_(i), may be calculated according toT_(i)=(S_(i)(wet)/R_(i)(wet))/(S_(i)(air)/R_(i)(air)), where S_(i)denotes the sample signal from the sample detector 2036 and denotes thecorresponding reference signal from the reference detector 2030. In someembodiments, the algorithm processor 416 calculates the optical density,OD_(i), as a logarithm of the transmittance, e.g., according toOD_(i)=−Log(T_(i)). In one implementation, the analyzer 2010 takes a setof wet readings in each of the N filter passbands and then takes a setof air readings in each of the N filter passbands. In other embodiments,the analyzer 2010 may take an air reading before (or after) thecorresponding wet reading.

The optical density OD_(i) is the product of the absorption coefficientat wavelength times the pathlength L over which the sample energy beamE_(s) interacts with the substance in the sample cell 2048, e.g.,OD_(i)=α_(i) L. The absorption coefficient α_(i) of a substance may bewritten as the product of an absorptivity per mole times a molarconcentration of the substance. FIG. 20 schematically illustrates thepathlength L of the sample cell 2048. The pathlength L may be determinedfrom spectral measurements made when the sample cell 2048 is filled witha reference substance. For example, because the absorption coefficientfor water (or saline) is known, one or more water (or saline) readingscan be used to determine the pathlength L from measurements of thetransmittance (or optical density) through the cell 2048. In someembodiments, several readings are taken in different wavelengthpassbands, and a curve-fitting procedure is used to estimate a best-fitpathlength L. The pathlength L may be estimated using other methodsincluding, for example, measuring interference fringes of light passingthrough an empty sample cell 2048.

The pathlength L may be used to determine the absorption coefficients ofthe fluid sample at each wavelength. Molar concentration of an analyteof interest can be determined from the absorption coefficient and theknown molar absorptivity of the analyte. In some embodiments, a samplemeasurement cycle comprises a saline reading (at one or morewavelengths), a set of N wet readings (taken, for example, through asample cell 2048 containing saline solution), followed by a set of N airreadings (taken, for example, through the opposite opening 1530). Asdiscussed above, the sample measurement cycle can be performed in agiven length of time that may depend, at least in part, on filter dwelltimes. For example, the measurement cycle may take five minutes when thefilter dwell times are about five seconds. In some embodiments, themeasurement cycle may take about two minutes when the filter dwell timesare about two seconds. After the sample measurement cycle is completed,a detergent cleaner may be flushed through the sample cell 2048 toreduce buildup of organic matter (e.g., proteins) on the windows of thesample cell 2048. The detergent is then flushed to a waste bladder.

In some embodiments, the system stores information related to thespectral measurements so that the information is readily available forrecall by a user. The stored information can includewavelength-dependent spectral measurements (including fluid sample, air,and/or saline readings), computed analyte values, system temperaturesand electrical properties (e.g., voltages and currents), and any otherdata related to use of the system (e.g., system alerts, vibrationreadings, SN ratios, etc.). The stored information may be retained inthe system for a time period such as, for example, 30 days. After thistime period, the stored information may be communicated to an archivaldata storage system and then deleted from the system. In someembodiments, the stored information is communicated to the archival datastorage system via wired or wireless methods, e.g., over a hospitalinformation system (HIS).

Analyte Analysis

The algorithm processor 416 (FIG. 4) (or any other suitable processor orprocessors) may be configured to receive from the analyzer 2010 thewavelength-dependent optical measurements C_(s)(λ_(i)) of the fluidsample. In some embodiments, the optical measurements comprise spectrasuch as, for example, optical densities OD_(i) measured in each of the Nfilter passbands centered around wavelengths The optical measurementsC_(s)(λ_(i)) are communicated to the processor 416, which analyzes theoptical measurements to detect and quantify one or more analytes in thepresence of interferents. In some embodiments, one or more poor qualityoptical measurements C_(s)(λ_(i)) are rejected (e.g., as having a S/Nratio that is too low), and the analysis performed on the remaining,sufficiently high-quality measurements. In another embodiment,additional optical measurements of the fluid sample are taken by theanalyzer 2010 to replace one or more of the poor quality measurements.

Interferents can comprise components of a material sample being analyzedfor an analyte, where the presence of the interferent affects thequantification of the analyte. Thus, for example, in the spectroscopicanalysis of a sample to determine an analyte concentration, aninterferent could be a compound having spectroscopic features thatoverlap with those of the analyte, in at least a portion of thewavelength range of the measurements. The presence of such aninterferent can introduce errors in the quantification of the analyte.More specifically, the presence of one or more interferents can affectthe sensitivity of a measurement technique to the concentration ofanalytes of interest in a material sample, especially when the system iscalibrated in the absence of, or with an unknown amount of, theinterferent.

Independently of or in combination with the attributes of interferentsdescribed above, interferents can be classified as being endogenous(i.e., originating within the body) or exogenous (i.e., introduced fromor produced outside the body). As an example of these classes ofinterferents, consider the analysis of a blood sample (or a bloodcomponent sample or a blood plasma sample) for the analyte glucose.Endogenous interferents include those blood components having originswithin the body that affect the quantification of glucose, and caninclude water, hemoglobin, blood cells, and any other component thatnaturally occurs in blood. Exogenous interferents include those bloodcomponents having origins outside of the body that affect thequantification of glucose, and can include items administered to aperson, such as medicaments, drugs, foods or herbs, whether administeredorally, intravenously, topically, etc.

Independently of or in combination with the attributes of interferentsdescribed above, interferents can comprise components which arepossibly, but not necessarily, present in the sample type underanalysis. In the example of analyzing samples of blood or blood plasmadrawn from patients who are receiving medical treatment, a medicamentsuch as acetaminophen is possibly, but not necessarily, present in thissample type. In contrast, water is necessarily present in such blood orplasma samples.

Certain disclosed analysis methods are particularly effective if eachanalyte and interferent has a characteristic signature in themeasurement (e.g., a characteristic spectroscopic feature), and if themeasurement is approximately affine (e.g., includes a linear term and anoffset) with respect to the concentration of each analyte andinterferent. In such methods, a calibration process is used to determinea set of one or more calibration coefficients and a set of one or moreoptional offset values that permit the quantitative estimation of ananalyte. For example, the calibration coefficients and the offsets maybe used to calculate an analyte concentration from spectroscopicmeasurements of a material sample (e.g., the concentration of glucose inblood plasma). In some of these methods, the concentration of theanalyte is estimated by multiplying the calibration coefficient by ameasurement value (e.g., an optical density) to estimate theconcentration of the analyte. Both the calibration coefficient andmeasurement can comprise arrays of numbers. For example, in someembodiments, the measurement comprises spectra C_(s)(λ_(i)) measured atthe wavelengths L, and the calibration coefficient and optional offsetcomprise an array of values corresponding to each wavelength λ_(i). Insome embodiments, as further described below, a hybrid linear analysis(HLA) technique is used to estimate analyte concentration in thepresence of a set of interferents, while retaining a high degree ofsensitivity to the desired analyte. The data used to accommodate the setof possible interferents can include (a) signatures of each of themembers of the family of potential additional substances and (b) atypical quantitative level at which each additional substance, ifpresent, is likely to appear. In some embodiments, the calibrationcoefficient (and optional offset) are adjusted to minimize or reduce thesensitivity of the calibration to the presence of interferents that areidentified as possibly being present in the fluid sample.

In some embodiments, the analyte analysis method uses a set of trainingspectra each having known analyte concentration and produces acalibration that minimizes the variation in estimated analyteconcentration with interferent concentration. The resulting calibrationcoefficient indicates sensitivity of the measurement to analyteconcentration. The training spectra need not include a spectrum from theindividual whose analyte concentration is to be determined. That is, theterm “training” when used in reference to the disclosed methods does notrequire training using measurements from the individual whose analyteconcentration will be estimated (e.g., by analyzing a bodily fluidsample drawn from the individual).

Several terms are used herein to describe the analyte analysis process.The term “Sample Population” is a broad term and includes, withoutlimitation, a large number of samples having measurements that are usedin the computation of calibration values (e.g., calibration coefficientsand optional offsets). In some embodiments, the term Sample Populationcomprises measurements (such as, e.g., spectra) from individuals and maycomprise one or more analyte measurements determined from those sameindividuals. Additional demographic information may be available for theindividuals whose sample measurements are included in the SamplePopulation. For an embodiment involving the spectroscopic determinationof glucose concentration, the Sample Population measurements may includea spectrum (measurement) and a glucose concentration (analytemeasurement).

Various embodiments of Sample Populations may be used in variousembodiments of the systems and methods described herein. Severalexamples of Sample Populations will now be described. These examples areintended to illustrate certain aspects of possible Sample Populationembodiments but are not intended to limit the types of SamplePopulations that may be generated. In certain embodiments, a SamplePopulation may include samples from one or more of the example SamplePopulations described below.

In some embodiments of the systems and methods described herein, one ormore Sample Populations are included in a “Population Database.” ThePopulation Database may be implemented and/or stored on acomputer-readable medium. In certain embodiments, the systems andmethods may access the Population Database using wired and/or wirelesstechniques. Certain embodiments may utilize several different PopulationDatabases that are accessible locally and/or remotely. In someembodiments, the Population Database includes one or more of the exampleSample Populations described below. In some embodiments, two or moredatabases can be combined into a single database, and in otherembodiments, any one database can be divided into multiple databases.

An example Sample Population may comprise samples from individualsbelonging to one or more demographic groups including, for example,ethnicity, nationality, gender, age, etc. Demographic groups may beestablished for any suitable set of one or more distinctive factors forthe group including, for example, medical, cultural, behavioral,biological, geographical, religious, and genealogical traits. Forexample, in certain embodiments, a Sample Population includes samplesfrom individuals from a specific ethnic group (e.g., Caucasians,Hispanics, Asians, African Americans, etc.). In another embodiment, aSample Population includes samples from individuals of a specific genderor a specific race. In some embodiments, a Sample Population includessamples from individuals belonging to more than one demographic group(e.g., samples from Caucasian women).

Another example Sample Population can comprise samples from individualshaving one or more medical conditions. For example, a Sample Populationmay include samples from individuals who are healthy and unmedicated(sometimes referred to as a Normal Population). In some embodiments, theSample Population includes samples from individuals having one or morehealth conditions (e.g., diabetes). In some embodiments, the SamplePopulation includes samples from individuals taking one or moremedications. In certain embodiments, Sample Population includes samplesfrom individuals diagnosed to have a certain medical condition or fromindividuals being treated for certain medical conditions or somecombination thereof. The Sample Population may include samples fromindividuals such as, for example, ICU patients, maternity patients, andso forth.

An example Sample Population may comprise samples that have the sameinterferent or the same type of interferents. In some embodiments, aSample Population can comprise multiple samples, all lacking aninterferent or a type of interferent. For example, a Sample Populationmay comprise samples that have no exogenous interferents, that have oneor more exogenous interferents of either known or unknown concentration,and so forth. The number of interferents in a sample depends on themeasurement and analyte(s) of interest, and may number, in general, fromzero to a very large number (e.g., greater than 300). All of theinterferents typically are not expected to be present in a particularmaterial sample, and in many cases, a smaller number of interferents(e.g., 0, 1, 2, 5, 10, 15, 20, or 25) may be used in an analysis. Incertain embodiments, the number of interferents used in the analysis isless than or equal to the number of wavelength-dependent measurements Nin the spectrum C_(s)(λ_(i)).

Certain embodiments of the systems and methods described herein arecapable of analyzing a material sample using one or more SamplePopulations (e.g., accessed from the Population Database). Certain suchembodiments may use information regarding some or all of theinterferents which may or may not be present in the material sample. Insome embodiments, a list of one or more possible interferents, referredto herein as forming a “Library of Interferents,” can be compiled. Eachinterferent in the Library can be referred to as a “LibraryInterferent.” The Library Interferents may include exogenousinterferents and endogenous interferents that may be present in amaterial sample. For example, an interferent may be present due to amedical condition causing abnormally high concentrations of theexogenous and endogenous interferents. In some embodiments, the Libraryof Interferents may not include one or more interferents that are knownto be present in all samples. Thus, for example, water, which is aglucose interferent for many spectroscopic measurements, may not beincluded in the Library of Interferents. In certain embodiments, thesystems and methods use samples in the Sample Population to traincalibration methods.

The material sample being measured, for example a fluid sample in thesample cell 2048, may also include one or more Library Interferentswhich may include, but is not limited to, an exogenous interferent or anendogenous interferent. Examples of exogenous interferent can includemedications, and examples of endogenous interferents can include urea inpersons suffering from renal failure. In addition to componentsnaturally found in the blood, the ingestion or injection of somemedicines or illicit drugs can result in very high and rapidly changingconcentrations of exogenous interferents.

In some embodiments, measurements of a material sample (e.g., a bodilyfluid sample), samples in a Sample Population, and the LibraryInterferents comprise spectra (e.g., infrared spectra). The spectraobtained from a sample and/or an interferent may be temperaturedependent. In some embodiments, it may be beneficial to calibrate fortemperatures of the individual samples in the Sample Population or theinterferents in the Library of Interferents. In some embodiments, atemperature calibration procedure is used to generate a temperaturecalibration factor that substantially accounts for the sampletemperature. For example, the sample temperature can be measured, andthe temperature calibration factor can be applied to the SamplePopulation and/or the Library Interferent spectral data. In someembodiments, a water or saline spectrum is subtracted from the samplespectrum to account for temperature effects of water in the sample.

In other embodiments, temperature calibration may not be used. Forexample, if Library Interferent spectra, Sample Population spectra, andsample spectra are obtained at approximately the same temperature, anerror in a predicted analyte concentration may be within an acceptabletolerance. If the temperature at which a material sample spectrum ismeasured is within, or near, a temperature range (e.g., several degreesCelsius) at which the plurality of Sample Population spectra areobtained, then some analysis methods may be relatively insensitive totemperature variations. Temperature calibration may optionally be usedin such analysis methods.

Systems and Methods for Estimating Analyte Concentration in the Presenceof Interferents

FIG. 21 is a flowchart that schematically illustrates an embodiment of amethod 2100 for estimating the concentration of an analyte in thepresence of interferents. In block 2110, a measurement of a sample isobtained, and in block 2120 data relating to the obtained measurement isanalyzed to identify possible interferents to the analyte. In block2130, a model is generated for predicting the analyte concentration inthe presence of the identified possible interferents, and in block 2140the model is used to estimate the analyte concentration in the samplefrom the measurement. In certain embodiments of the method 2100, themodel generated in block 2130 is selected to reduce or minimize theeffect of identified interferents that are not present in a generalpopulation of which the sample is a member.

An example embodiment of the method 2100 of FIG. 21 for thedetermination of an analyte (e.g., glucose) in a blood sample will nowbe described. This example embodiment is intended to illustrate variousaspects of the method 2100 but is not intended as a limitation on thescope of the method 2100 or on the range of possible analytes. In thisexample, the sample measurement in block 2110 is an absorption spectrum,C_(s)(λ_(i)), of a measurement sample S that has, in general, oneanalyte of interest, glucose, and one or more interferents.

In block 2120, a statistical comparison of the absorption spectrum ofthe sample S with a spectrum of the Sample Population and combinationsof individual Library Interferent spectra is performed. The statisticalcomparison provides a list of Library Interferents that are possiblycontained in sample S and can include either no Library Interferents orone or more Library Interferents. In this example, in block 2130, one ormore sets of spectra are generated from spectra of the Sample Populationand their respective known analyte concentrations and known spectra ofthe Library Interferents identified in block 2120. In block 2130, thegenerated spectra are used to calculate a model for predicting theanalyte concentration from the obtained measurement. In someembodiments, the model comprises one or more calibration coefficientsκ(λ_(i)) that can be used with the sample measurements C_(s)(λ_(i)) toprovide an estimate of the analyte concentration, g_(est). In block2140, the estimated analyte concentration is determined form the modelgenerated in block 2130. For example, in some embodiments of HLA, theestimated analyte concentration is calculated according to a linearformula: g_(est)=κ(λ_(i))·C_(s)(λ_(i)). Because the absorptionmeasurements and calibration coefficients may represent arrays ofnumbers, the multiplication operation indicated in the preceding formulamay comprise a sum of the products of the measurements and coefficients(e.g., an inner product or a matrix product). In some embodiments, thecalibration coefficient is determined so as to have reduced or minimalsensitivity to the presence of the identified Library Interferents.

An example embodiment of block 2120 of the method 2100 will now bedescribed with reference to FIG. 22. In this example, block 2120includes forming a statistical Sample Population model (block 2210),assembling a library of interferent data (block 2220), assembling allsubsets of size K of the library interferents (block 2225), comparingthe obtained measurement and statistical Sample Population model withdata for each set of interferents from an interferent library (block2230), performing a statistical test for the presence of eachinterferent from the interferent library (block 2240), and identifyingpossible interferents that pass the statistical test (block 2250). Thesize K of the subsets may be an integer such as, for example, 1, 2, 3,4, 5, 6, 10, 16, or more. The acts of block 2220 can be performed onceor can be updated as necessary. In certain embodiments, the acts ofblocks 2230, 2240, and 2250 are performed sequentially for all subsetsof Library Interferents that pass the statistical test (block 2240). Inthis example, in block 2210, a Sample Population Database is formed thatincludes a statistically large Sample Population of individual spectrataken over the same wavelength range as the sample spectrum,C_(s)(λ_(i)). The Database also includes an analyte concentrationcorresponding to each spectrum. For example, if there are P SamplePopulation spectra, then the spectra in the Database can be representedas C={C₁, C₂, . . . , C_(P)}, and the analyte concentrationcorresponding to each spectrum can be represented as g={g₁, g₂, g_(P)}.In some embodiments, the Sample Population does not have any of theLibrary Interferents present, and the material sample has interferentscontained in the Sample Population and one or more of the LibraryInterferents.

In some embodiments of block 2210, the statistical sample modelcomprises a mean spectrum and a covariance matrix calculated for theSample Population. For example, if each spectrum measured at Nwavelengths L is represented by an N×1 array, C, then the mean spectrum,μ, is an N×1 array having values at each wavelength averaged over therange of spectra in the Sample Population. The covariance matrix, V, iscalculated as the expected value of the deviation between C and μ andcan be written as V=E((C−μ)(C−μ)^(T)) where E(·) represents the expectedvalue and the superscript T denotes transpose. In other embodiments,additional statistical parameters may be included in the statisticalmodel of the Sample Population spectra.

Additionally, a Library of Interferents may be assembled in block 2220.A number of possible interferents can be identified, for example, as alist of possible medications or foods that might be ingested by thepopulation of patients at issue. Spectra of these interferents can beobtained, and a range of expected interferent concentrations in theblood, or other expected sample material, can be estimated. In certainembodiments, the Library of Interferents includes, for each of “M”interferents, the absorption spectrum normalized to unit interferentconcentration of each interferent, IF={IF₁, IF₂, . . . , IF_(M)}, and arange of concentrations for each interferent from T_(max)={T_(max1),T_(max2), . . . , T_(maxM)) to T_(min)={T_(min1), T_(min2), . . . ,T_(minM)). Information in the Library may be assembled once and accessedas needed. For example, the Library and the statistical model of theSample Population may be stored in a storage device associated with thealgorithm processor 416 (see, FIG. 4).

Continuing in block 2225, the algorithm processor 416 assembles one ormore subsets comprising a number K of spectra taken from the Library ofInterferents. The number K may be an integer such as, for example, 1, 2,3, 4, 5, 6, 10, 16, or more. In some embodiments, the subsets compriseall combinations of the M Library spectra taken K at a time. In theseembodiments, the number of subsets having K spectra is M!/(K!(M−K)!),where ! represents the factorial function.

Continuing in block 2230, the obtained measurement data (e.g., thesample spectrum) and the statistical Sample Population model (e.g., themean spectrum and the covariance matrix) are compared with data for eachsubset of interferents determined in block 2225 in order to determinethe presence of possible interferents in the sample (block 2240). Insome embodiments, the statistical test for the presence of aninterferent subset in block 2240 comprises determining theconcentrations of each subset of interferences that minimize astatistical measure of “distance” between a modified spectrum of thematerial sample and the statistical model of the Sample Population(e.g., the mean μ and the covariance V). The term “concentration” usedin this context refers to a computed value, and, in some embodiments,that computed value may not correspond to an actual concentration. Theconcentrations may be calculated numerically. In some embodiments, theconcentrations are calculated by algebraically solving a set of linearequations. The statistical measure of distance may comprise thewell-known Mahalanobis distance (or square of the Mahalanobis distance)and/or some other suitable statistical distance metric (e.g.,Hotelling's T-square statistic). In certain implementations, themodified spectrum is given by C′_(s)(T)=C_(s)−IF·T where T=(T₁, T₂, . .. T_(K))^(T) is a K-dimensional column vector of interferentconcentrations and IF={IF₁, IF₂, . . . IF_(K)} represents the Kinterferent absorption spectra of the subset. In some embodiments,concentration of the i^(th) interferent is assumed to be in a range froma minimum value, Tmin_(i), to a maximum value, Tmax_(i). The value ofTmin_(i) may be zero, or may be a value between zero and Tmax_(i), suchas a fraction of Tmax_(i), or may be a negative value. Negative valuesrepresent interferent concentrations that are smaller than baselineinterferent values in the Sample Population.

In block 2250, a list of a number N_(S) of possible interferent subsetsξ may be identified as the particular subsets that pass one or morestatistical tests (in block 2240) for being present in the materialsample. One or more statistical tests may be used, alone or incombination, to identify the possible interferents. For example, if astatistical test indicates that an i^(th) interferent is present in aconcentration outside the range Tmin_(i) to Tmax_(i), then this resultmay be used to exclude the i^(th) interferent from the list of possibleinterferents. In some embodiments, only the single most probableinterferent subset is included on the list, for example, the subsethaving the smallest statistical distance (e.g., Mahalanobis distance).In an embodiment, the list includes the subsets ξ having statisticaldistances smaller than a threshold value. In certain embodiments, thelist includes a number N_(S) of subsets having the smallest statisticaldistances, e.g., the list comprises the “best” candidate subsets. Thenumber N_(S) may be any suitable integer such as 10, 20, 50, 100, 200,or more. An advantage of selecting the “best” N_(S) subsets is reducedcomputational burden on the algorithm processor 416. In someembodiments, the list includes all the Library Interferents. In certainsuch embodiments, the list is selected to comprise combinations of theN_(S) subsets taken L at a time. For example, in some embodiments, pairsof subsets are taken (e.g., L=2). An advantage of selecting pairs ofsubsets is that pairing captures the most likely combinations ofinterferents and the “best” candidates are included multiple times inthe list of possible interferents. In embodiments in which combinationsof L subsets are selected, the number of combinations of subsets in thelist of possible interferent subsets is N_(S)!/(L!(N_(S)−L)!).

In other embodiments, the list of possible interferent subsets ξ isdetermined using a combination of some or all of the above criteria. Inanother embodiment, the list of possible interferent subsets ξ includeseach of the subsets assembled in block 2225. Many selection criteria arepossible for the list of possible interferent subsets ξ.

Returning to FIG. 21, the method 2100 continues in block 2130 whereanalyte concentration is estimated in the presence of the possibleinterferent subsets ξ determined in block 2250. FIG. 23 is a flowchartthat schematically illustrates an example embodiment of the acts ofblock 2130. In block 2310, synthesized Sample Population measurementsare generated to form an Interferent Enhanced Spectral Database (IESD).In block 2360, the IESD and known analyte concentrations are used togenerate calibration coefficients for the selected interferent subset.As indicated in block 2365, blocks 2310 and 2360 may be repeated foreach interferent subset identified in the list of possible interferentsubsets (e.g., in block 2250 of FIG. 22). In this example embodiment,when all the interferent subsets ξ have been processed, the methodcontinues in block 2370, wherein an average calibration coefficient isapplied to the measured spectra to determine a set of analyteconcentrations.

In one example embodiment for block 2310, synthesized Sample Populationspectra are generated by adding random concentrations of eachinterferent in one of the possible interferent subsets ξ. These spectraare referred to herein as an Interferent-Enhanced Spectral Database orIESD. In one example method, the IESD is formed as follows. A pluralityof Randomly-Scaled Single Interferent Spectra (RSIS) are formed for eachinterferent in the interferent subset Each RSIS is formed bycombinations of the interferent having spectrum IF multiplied by themaximum concentration Tmax, which is scaled by a random factor betweenzero and one. In certain embodiments, the scaling places the maximumconcentration at the 95′ percentile of a log-normal distribution inorder to generate a wide range of concentrations. In some embodiments,the log-normal distribution has a standard deviation equal to half ofits mean value.

In this example method, individual RSIS are then combined independentlyand in random combinations to form a large family of CombinationInterferent Spectra (CIS), with each spectrum in the CIS comprising arandom combination of RSIS, selected from the full set of identifiedLibrary Interferents. An advantage of this method of selecting the CISis that it produces adequate variability with respect to eachinterferent, independently across separate interferents.

The CIS and replicates of the Sample Population spectra are combined toform the IESD. Since the interferent spectra and the Sample Populationspectra may have been obtained from measurements having differentoptical pathlengths, the CIS may be scaled to the same pathlength as theSample Population spectra. The Sample Population Database is thenreplicated R times, where R depends on factors including the size of theDatabase and the number of interferents. The IESD includes R copies ofeach of the Sample Population spectra, where one copy is the originalSample Population Data, and the remaining R-1 copies each have onerandomly chosen CIS spectra added. Accordingly, each of the IESD spectrahas an associated analyte concentration from the Sample Populationspectra used to form the particular IESD spectrum. In some embodiments,a 10-fold replication of the Sample Population Database is used for 130Sample Population spectra obtained from 58 different individuals and 18Library Interferents. A smaller replication factor may be used if thereis greater spectral variety among the Library Interferent spectra, and alarger replication factor may be used if there is a greater number ofLibrary Interferents.

After the IESD is generated in block 2310, in block 2360, the IESDspectra and the known, random concentrations of the subset interferentsare used to generate a calibration coefficient for estimating theanalyte concentration from a sample measurement. The calibrationcoefficient is calculated in some embodiments using a hybrid linearanalysis (HLA) technique. In certain embodiments, the HLA technique usesa reference analyte spectrum to construct a set of spectra that are freeof the desired analyte, projecting the analyte's spectrum orthogonallyaway from the space spanned by the analyte-free calibration spectra, andnormalizing the result to produce a unit response. Further descriptionof embodiments of HLA techniques may be found in, for example,“Measurement of Analytes in Human Serum and Whole Blood Samples byNear-Infrared Raman Spectroscopy,” Chapter 4, Andrew J. Berger, Ph. D.thesis, Massachusetts Institute of Technology, 1998, and “An EnhancedAlgorithm for Linear Multivariate Calibration,” by Andrew J. Berger, etal., Analytical Chemistry, Vol. 70, No. 3, Feb. 1,1998, pp. 623-627, theentirety of each of which is hereby incorporated by reference herein. Inother embodiments, the calibration coefficients may be calculated usingother techniques including, for example, regression techniques such as,for example, ordinary least squares (OLS), partial least squares (PLS),and/or principal component analysis.

In block 2365, the processor 416 determines whether additionalinterferent subsets ξ remain in the list of possible interferentsubsets. If another subset is present in the list, the acts in blocks2310-2360 are repeated for the next subset of interferents usingdifferent random concentrations. In some embodiments, blocks 2310-2360are performed for only the most probable subset on the list.

The calibration coefficient determined in block 2360 corresponds to asingle interferent subset ξ from the list of possible interferentsubsets and is denoted herein as a single-interferent-subset calibrationcoefficient K_(avg)(ξ). In this example method, after all subsets ξ havebeen processed, the method continues in block 2370, in which thesingle-interferent-subset calibration coefficient is applied to themeasured spectra C_(s) to determine an estimated,single-interferent-subset analyte concentration, g(ξ)=k_(avg)(ξ)·C_(s),for the interferent subset ξ. The set of the estimated,single-interferent-subset analyte concentrations g(ξ) for all subsets inthe list may be assembled into an array of single-interferent-subsetconcentrations. As noted above, in some embodiments the blocks 2310-2370are performed once for the most probable single-interferent-subset onthe list (e.g., the array of single-interferent analyte concentrationshas a single member).

Returning to block 2140 of FIG. 21, the array ofsingle-interferent-subset concentrations, g(ξ), is combined to determinean estimated analyte concentration, g_(est), for the material sample. Incertain embodiments, a weighting function p(ξ) is determined for each ofthe interferent subsets ξ on the list of possible interferent subsets.The weighting functions may be normalized such that Σp(ξ)=1, where thesum is over all subsets ξ that have been processed from the list ofpossible interferent subsets. In some embodiments, the weightingfunctions can be related to the minimum Mahalanobis distance or anoptimal concentration. In certain embodiments, the weighting functionp(ξ), for each subset ξ, is selected to be a constant, e.g., 1/N_(S)where N_(S) is the number of subsets processed from the list of possibleinterferent subsets. In other embodiments, other weighting functionsp(ξ) can be selected.

In certain embodiments, the estimated analyte concentration, g_(est), isdetermined (in block 2140) by combining the single-interferent-subsetestimates, g(ξ), and the weighting functions, p(ξ), to generate anaverage analyte concentration. The average concentration may be computedaccording to g_(est)=Σg(ξ) p(ξ), where the sum is over the interferentsubsets processed from the list of possible interferent subsets. In someembodiments, the weighting function p(ξ) is a constant value for eachsubset (e.g., a standard arithmetic average is used for determiningaverage analyte concentration). By testing the above described examplemethod on simulated data, it has been found that the average analyteconcentration advantageously has errors that may be reduced incomparison to other methods (e.g., methods using only a single mostprobable interferent).

Although the flowchart in FIG. 21 schematically illustrates anembodiment of the method 2100 performed with reference to the blocks2110-2140 described herein, in other embodiments, the method 2100 can beperformed differently. For example, some or all of the blocks 2110-2140can be combined, performed in a different order than shown, and/or thefunctions of particular blocks may be reallocated to other blocks and/orto different blocks. Embodiments of the method 2100 may utilizedifferent blocks than are shown in FIG. 21.

For example, in some embodiments of the method 2100, the calibrationcoefficient is computed without synthesizing spectra and/or partitioningthe data into calibration sets and test sets. Such embodiments arereferred to herein as “Parameter-Free Interferent Rejection” (PFIR)methods. In one example embodiment using PFIR, for each of the possibleinterferent subsets ξ, the following calculations may be performed tocompute an estimate of a calibration coefficient for each subset ξ. Anaverage concentration may be estimated according to g_(est)=Σg(ξ) p(ξ),where the sum is over the interferent subsets processed from the list ofpossible interferent subsets.

An example of an alternative embodiment of block 2130 includes thefollowing steps and calculations.

Step 1: For a subset's NIF interferents, form a scaled interferentspectra matrix. In certain embodiments, the scaled interferent spectramatrix is the product of an interferent spectral matrix, IF, multipliedby an interferent concentration matrix, T_(max), and can be written as:IF T_(max). In certain such embodiments, the interferent concentrationmatrix T_(max) is a diagonal matrix having entries given by the maximumplasma concentrations for the various interferents.

Step 2: Calculate a covariance for the interferent component. If Xdenotes the IESD, the covariance of X, cov(X), is defined as theexpectation E((X−mean(X))(X−mean(X))^(T)) and is

cov(X)≈X X ^(T)/(N−1)−mean(X) mean(X)^(T).

As described above, the IESD (e.g., X) is obtained as a combination ofSample Population Spectra, C, with Combination Interferent Spectra(CIS): X_(j)=C_(j)+IF_(j) ξ_(j), therefore the covariance is:

cov(X)≈C C ^(T)/(N−1)+IF ΞΞ ^(T) IF ^(T) /(N−1)−mean(X) mean(X)^(T),

which can be written as,

cov(X)≈cov(C)+IF cov(Ξ) IF ^(T).

If the weights in the weighting matrix Ξ are independent and identicallydistributed, the covariance of Ξ, cov(Ξ), is a diagonal matrix havingalong the diagonal the variance, v, of the samples in Ξ. The lastequation may be written as

cov(X)≈V ₀ v Φ,

where V₀ is the covariance of the original sample population and Φ isthe covariance of the IF spectral set.

Step 3: The group's covariance may be at least partially corrected forthe presence of a single replicate of the Sample Population spectra withthe IESD as formed from NIF replicates of the Sample Population Spectrawith Combined Interferent Spectra. This partial correction may beachieved by multiplying the second term in the covariance formula givenabove by a correction factor ρ:

V=V ₀ +ρvΦ,

where ρ is a scalar weighting function that depends on the number ofinterferents in the group. In some embodiments, the scalar weightingfunction is ρ=N_(IF)/(N_(IF)+1). In certain embodiments, the variance vof the weights is assumed to be the variance of a log-normal randomvariable having a 95th percentile at a value of 1.0, and a standarddeviation equal to half of the mean value.

Step 4: The eigenvectors and the corresponding eigenvalues of thecovariance matrix V are determined using any suitable linear algebraicmethods. The number of eigenvectors (and eigenvalues) is equal to thenumber of wavelengths L in the spectral measurements. The eigenvectorsmay be sorted based on decreasing order of their correspondingeigenvalues.

Step 5: The matrix of eigenvectors is decomposed so as to provide anorthogonal matrix Q. For example, in some embodiments, aQR-decomposition is performed, thereby yielding the matrix Q havingorthonormal columns and rows.

Step 6: The following matrix operations are performed on the orthogonalmatrix Q. For n=2 to L−1, the product P^(∥) _(n)=Q(:,1:n) Q(:,1:n)^(T)is calculated, where Q(:,1:n) denotes the submatrix comprising the firstn columns of the full matrix Q. The orthogonal projection, P^(⊥) _(n),away from the space spanned by Q(:,1:n) is determined by subtractingP^(∥) _(n) from the L×L identity matrix I. The n^(th) calibration vectoris then determined from κ_(n)=P^(⊥) _(n) αx/αx ^(T)P^(⊥) _(n) αx, andthe n^(th) error variance E_(n) is determined as the projection of thefull covariance V onto the subspace spanned by κ_(n) as follows:E_(n)=κ_(n) ^(T) V κ_(n).

The steps 4-6 of this example are an embodiment of the HLA technique.

In some embodiments, the calibration coefficient κ is selected as thecalibration vector corresponding to the minimum error variance E_(n).Thus, for example, the average group calibration coefficient κ may befound by searching among all the error variances for the error varianceE_(n) that has the minimum value. The calibration coefficient is thenselected as the n^(th) calibration vector κ_(n) corresponding to theminimum error variance E_(n). In other embodiments, the calibrationcoefficient is determined by averaging some or all of the calibrationvectors κ_(n).

Examples of Algorithm Results and Effects of Sample Population

Embodiments of the above-described methods have been used to estimateblood plasma glucose concentrations in humans. Four example experimentswill now be described. The population of individuals from whom sampleswere obtained for analysis (estimation of glucose concentration) will bereferred to as the “target population.” Infrared spectra obtained fromthe target population will be referred to as the “target spectra.” Inthe four example experiments, the target population included 41intensive care unit (ICU) patients. Fifty-five samples were obtainedfrom the target population.

EXAMPLE EXPERIMENT 1

In this example experiment, a partial least squares (PLS) regressionmethod was applied to the infrared target spectra of the targetpatients' blood plasma to obtain the glucose estimates. In exampleexperiment 1, estimated glucose concentration was not corrected foreffects of interferents. The Sample Population used for the analysisincluded infrared spectra and independently measured glucoseconcentrations for 92 individuals selected from the general population.This Sample Population will be referred to as a “Normal Population.”

EXAMPLE EXPERIMENT 2

In example experiment 2, an embodiment of the Parameter-Free InterferentRejection (PFIR) method was used to estimate glucose concentration forthe same target population of patients in example experiment 1. TheSample Population was the Normal Population. In this example,calibration for Library Interferents was applied to the measured targetspectra. The Library of Interferents included spectra of the 59substances listed below:

TABLE 2 Library of Interferents Acetylsalicylic Acid Hetastarch PyruvateSodium Ampicillin Human Albumin Pyruvic Acid Sulbactam AzithromycinHydroxy Butyric Acid Salicylate Sodium Aztreonam Imipenem CilastatinSodium Acetate Bacitracin Iohexol Sodium Bicarbonate Benzyl AlcoholL_Arginine Sodium Chloride Calcium Chloride Lactate Sodium SodiumCitrate Calcium Gluconate Magnesium Sulfate Sodium Thiosulfate CefazolinMaltose Sulfadiazine Cefoparazone Mannitol Urea Cefotaxime SodiumMeropenem Uric Acid Ceftazidime Oxylate Potassium VoriconazoleCeftriaxone Phenytoin Xylitol D_Sorbitol Phosphates Potassium XyloseDextran Piperacillin PC 1 of Saline covariance Ertapenem Piperacillin PC2 of Saline covariance Tazobactam Ethanol PlasmaLyteA PC 3 of Salinecovariance Ethosuximide Procaine HCl PC 4 of Saline covariance GlycerolPropylene Glycol ICU/Normal difference spectrum Heparin Pyrazinamide

In some embodiments, the calibration data set is determined according totwo criteria: the calibration method itself (e.g., HLA, PLS, OLS, PFIR)and the intended application of the method. The calibration data set maycomprise spectra and corresponding analyte levels derived from a set ofplasma samples from the Sample Population. In some embodiments, e.g.,those where an HLA calibration method is used, the calibration data setmay also include spectra of the analyte of interest.

In the example experiments 1 and 2, the Sample Population was the NormalPopulation. Thus, samples were drawn from a population of normalindividuals who did not have identifiable medical conditions that mightaffect the spectra of their plasma samples. For example, the sampleplasma spectra typically did not show effects of high levels ofmedications or other substances (e.g., ethanol), or effects of chemicalsthat are indicative of kidney or liver malfunction.

In some embodiments, an analysis method may calibrate for deviationsfrom the distribution defined by the calibration plasma spectra byidentifying a “base” set of interferent spectra likely to be responsiblefor the deviation. The analysis method may then recalibrate with respectto an enhanced spectral data set. In some embodiments, the enhancementcan be achieved by including the identified interferent spectra into thecalibration plasma spectra. When it is anticipated that the targetpopulation may have been administered significant amounts of substancesnot present in the samples of the calibration set, or when the targetpopulation have many distinct interferents, estimation of theinterferents present in the target spectrum may be subject to a largedegree of uncertainty. In some cases, this may cause analyte estimationto be subject to errors.

Accordingly, in certain embodiments, the calibration data set may beenhanced beyond the base of “normal” samples to include a population ofsamples intended to be more representative of the target population. Theenhancement of the calibration set may be generated, in someembodiments, by including samples from a sufficiently diverse range ofindividuals in order to represent the range of likely interferents (bothin type and in concentration) and/or the normal variability inunderlying plasma characteristics. The enhancement may, additionally oralternatively, be generated by synthesizing interferent spectra having arange of concentrations as described above (see, e.g., discussion ofblock 2310 in FIG. 23). Using the enhanced calibration set may reducethe error in estimating the analyte concentration in the target spectra.

EXAMPLE EXPERIMENTS 3 AND 4

Example experiments 3 and 4 use the analysis methods of exampleexperiments 1 and 2, respectively (PLS without interferent correctionand PFIR with interferent correction). However, example experiments 3and 4 use a Sample Population having blood plasma spectralcharacteristics different from the Normal Population used in exampleexperiments 1 and 2. In example experiments 3 and 4, the SamplePopulation was modified to include spectra of both the Normal Populationand spectra of an additional population of 55 ICU patients. Thesespectra will be referred to as the “Normal+Target Spectra.” Inexperiments 3 and 4, the ICU patients included Surgical ICU patients,Medical ICU patients as well as victims of severe trauma, including alarge proportion of patients who had suffered major blood loss. Majorblood loss may necessitate replacement of the patient's total bloodvolume multiple times during a single day and subsequent treatment ofthe patient via electrolyte and/or fluid replacement therapies. Majorblood loss may also require administration of plasma-expandingmedications. Major blood loss may lead to significant deviations fromthe blood plasma spectra representative of a Normal Population. Thepopulation of 55 ICU patients (who provided the Target Spectra) has somesimilarities to the individuals for whom the analyses in experiments 1-4were performed (e.g., all were ICU patients), but in these experiments,target spectra from individuals in the target population were notincluded in the Target Spectra.

Results of example experiments 1-4 are shown in the following table. Theglucose concentrations estimated from the analysis method were comparedto independently determined glucose measurements to provide an averageprediction error and a standard deviation of the average predictionerror. The table demonstrates that independent of the Sample Populationused (e.g., either the Normal Population or the Normal+TargetPopulation), calibrating for interferents reduces both the averageprediction error and the standard deviation (e.g., compare the resultsfor experiment 2 to the results for experiment 1 and compare the resultsfor experiment 4 to the results for experiment 3). The table furtherdemonstrates that independent of the analysis method used (e.g., eitherPLS or PFIR), using a Sample Population with more similarity to thetarget population (e.g., the Normal+Target Population) reduces both theaverage prediction error and the standard deviation (e.g., compare theresults for experiment 3 to the results for experiment 1 and compare theresults for experiment 4 to the results for experiment 2).

TABLE 3 Experiments 1-4 Average Example Prediction Standard ExperimentInterferent Sample Error Deviation No. Calibration Population (mg/dL)(mg/dL) 1 NO Normal 126 164 2 YES Normal −6.8 23.2 3 NO Normal + Target8.2 16.9 4 YES Normal + Target 1.32 12.6

Accordingly, embodiments of analysis methods that use a SamplePopulation that includes both normal spectra and spectra fromindividuals similar to those of the target population and that calibratefor possible interferents provide a good match between the estimatedglucose concentration and the measured glucose concentration. Asdiscussed above, a suitable Sample Population may be assembled from thePopulation Database in order to include normal spectra plus suitabletarget spectra from individuals that match a desired target populationincluding, for example, ICU patients, trauma patients, a particulardemographic group, a group having a common medical condition (e.g.,diabetes), and so forth.

User Interface

The system 400 can include a display system 414, for example, asdepicted in FIG. 4. The display system 414 may comprise an input deviceincluding, for example, a keypad or a keyboard, a mouse, a touchscreendisplay, and/or any other suitable device for inputting commands and/orinformation. The display system 414 may also include an output deviceincluding, for example, an LCD monitor, a CRT monitor, a touchscreendisplay, a printer, and/or any other suitable device for outputtingtext, graphics, images, videos, etc. In some embodiments, a touchscreendisplay is advantageously used for both input and output.

The display system 414 can include a user interface 2400 by which userscan conveniently and efficiently interact with the system 400. The userinterface 2400 may be displayed on the output device of the system 400(e.g., the touchscreen display). In some embodiments, the user interface2400 is implemented and/or stored as one or more code modules, which maybe embodied in hardware, firmware, and/or software.

FIGS. 24 and 25 schematically illustrate the visual appearance ofembodiments of the user interface 2400. The user interface 2400 may showpatient identification information 2402, which can include patient nameand/or a patient ID number. The user interface 2400 also can include thecurrent date and time 2404. An operating graphic 2406 shows theoperating status of the system 400. For example, as shown in FIGS. 24and 25, the operating status is “Running,” which indicates that thesystem 400 is fluidly connected to the patient (“Jill Doe”) andperforming normal system functions such as infusing fluid and/or drawingblood. The user interface 2400 can include one or more analyteconcentration graphics 2408, 2412, which may show the name of theanalyte and its last measured concentration. For example, the graphic2408 in FIG. 24 shows “Glucose” concentration of 150 mg/dL, while thegraphic 2412 shows “Lactate” concentration of 0.5 mmol/L. The particularanalytes displayed and their measurement units (e.g., mg/dL, mmol/L, orother suitable unit) may be selected by the user. The size of thegraphics 2408, 2412 may be selected to be easily readable out to adistance such as, e.g., 30 feet. The user interface 2400 may alsoinclude a next-reading graphic 2410 that indicates the time until thenext analyte measurement is to be taken. In FIG. 24, the time until nextreading is 3 minutes, whereas in FIG. 25, the time is 6 minutes, 13seconds.

The user interface 2400 can include an analyte concentration statusgraphic 2414 that indicates status of the patient's current analyteconcentration compared with a reference standard. For example, theanalyte may be glucose, and the reference standard may be a hospitalICU's tight glycemic control (TGC). In FIG. 24, the status graphic 2414displays “High Glucose,” because the glucose concentration (150 mg/dL)exceeds the maximum value of the reference standard. In FIG. 25, thestatus graphic 2414 displays “Low Glucose,” because the current glucoseconcentration (79 mg/dL) is below the minimum reference standard. If theanalyte concentration is within bounds of the reference standard, thestatus graphic 2414 may indicate normal (e.g., “Normal Glucose”), or itmay not be displayed at all. The status graphic 2414 may have abackground color (e.g., red) when the analyte concentration exceeds theacceptable bounds of the reference standard.

The user interface 2400 can include one or more trend indicators 2416that provide a graphic indicating the time history of the concentrationof an analyte of interest. In FIGS. 24 and 25, the trend indicator 2416comprises a graph of the glucose concentration (in mg/dL) versus elapsedtime (in hours) since the measurements started. The graph includes atrend line 2418 indicating the time-dependent glucose concentration. Inother embodiments, the trend line 2418 can include measurement errorbars and may be displayed as a series of individual data points. In FIG.25, the glucose trend indicator 2416 is shown as well as a trendindicator 2430 and trend line 2432 for the lactate concentration. Insome embodiments, a user may select whether none, one, or both trendindicators 2416, 2418 are displayed. In some embodiments, one or both ofthe trend indicators 2416, 2418 may appear only when the correspondinganalyte is in a range of interest such as, for example, above or belowthe bounds of a reference standard.

The user interface 2400 can include one or more buttons 2420-2426 thatcan be actuated by a user to provide additional functionality or tobring up suitable context-sensitive menus and/or screens. For example,in the embodiments shown in FIG. 24 and FIG. 25, four buttons 2420-2426are shown, although fewer or more buttons are used in other embodiments.The button 2420 (“End Monitoring”) may be pressed when one or moreremovable portions (see, e.g., 710 of FIG. 7) are to be removed. In manyembodiments, because the removable portions 710, 712 are not reusable, aconfirmation window appears when the button 2420 is pressed. If the useris certain that monitoring should stop, the user can confirm this byactuating an affirmative button in the confirmation window. If thebutton 2420 were pushed by mistake, the user can select a negativebutton in the confirmation window. If “End Monitoring” is confirmed, thesystem 400 performs appropriate actions to cease fluid infusion andblood draw and to permit ejection of a removable portion (e.g., theremovable portion 710).

The button 2422 (“Pause”) may be actuated by the user if patientmonitoring is to be interrupted but is not intended to end. For example,the “Pause” button 2422 may be actuated if the patient is to betemporarily disconnected from the system 400 (e.g., by disconnecting thetubes 306). After the patient is reconnected, the button 2422 may bepressed again to resume monitoring. In some embodiments, after the“Pause” button 2422 has been pressed, the button 2422 displays “Resume.”

The button 2424 (“Delay 5 Minutes”) causes the system 400 to delay thenext measurement by a delay time period (e.g., 5 minutes in the depictedembodiments). Actuating the delay button 2424 may be advantageous iftaking a reading would be temporarily inconvenient, for example, becausea health care professional is attending to other needs of the patient.The delay button 2424 may be pressed repeatedly to provide longerdelays. In some embodiments, pressing the delay button 2424 isineffective if the accumulated delay exceeds a maximum threshold. Thenext-reading graphic 2410 automatically increases the displayed timeuntil the next reading for every actuation of the delay button 2424 (upto the maximum delay).

The button 2426 (“Dose History”) may be actuated to bring up a dosinghistory window that displays patient dosing history for an analyte ormedicament of interest. For example, in some embodiments, the dosinghistory window displays insulin dosing history of the patient and/orappropriate hospital dosing protocols. A nurse attending the patient canactuate the dosing history button 2426 to determine the time when thepatient last received an insulin dose, the last dosage amount, and/orthe time and amount of the next dosage. The system 400 may receive thepatient dosing history via wired or wireless communications from ahospital information system.

In other embodiments, the user interface 2400 can include additionaland/or different buttons, menus, screens, graphics, etc. that are usedto implement additional and/or different functionalities.

Related Components

FIG. 26 schematically depicts various components and/or aspects of apatient monitoring system 2630 and how those components and/or aspectsrelate to each other. In some embodiments, the monitoring system 2630can be the apparatus 100 for withdrawing and analyzing fluid samples.Some of the depicted components can be included in a kit containing aplurality of components. Some of the depicted components, including, forexample, the components represented within the dashed rounded rectangle2640 of FIG. 26, are optional and/or can be sold separately from othercomponents.

The patient monitoring system 2630 shown in FIG. 26 includes amonitoring apparatus 2632. The monitoring apparatus 2632 can be themonitoring device 102, shown in FIG. 1 and/or the system 400 of FIG. 4.The monitoring apparatus 2632 can provide monitoring of physiologicalparameters of a patient. In some embodiments, the monitoring apparatus2632 measures glucose and/or lactate concentrations in the patient'sblood. In some embodiments, the measurement of such physiologicalparameters is substantially continuous. The monitoring apparatus 2632may also measure other physiological parameters of the patient. In someembodiments, the monitoring apparatus 2632 is used in an intensive careunit (ICU) environment. In some embodiments, one monitoring apparatus2632 is allocated to each patient room in an ICU.

The patient monitoring system 2630 can include an optional interfacecable 2642. In some embodiments, the interface cable 2642 connects themonitoring apparatus 2632 to a patient monitor (not shown). Theinterface cable 2642 can be used to transfer data from the monitoringapparatus 2632 to the patient monitor for display. In some embodiments,the patient monitor is a bedside cardiac monitor having a display thatis located in the patient room (see, e.g., the user interface 2400 shownin FIG. 24 and FIG. 25.) In some embodiments, the interface cable 2642transfers data from the monitoring apparatus 2632 to a central stationmonitor and/or to a hospital information system (HIS). The ability totransfer data to a central station monitor and/or to a HIS may depend onthe capabilities of the patient monitor system.

In the embodiment shown in FIG. 26, an optional bar code scanner 2644 isconnected to the monitoring apparatus 2632. In some embodiments, the barcode scanner 2644 is used to enter patient identification codes, nurseidentification codes, and/or other identifiers into the monitoringapparatus 2632. In some embodiments, the bar code scanner 2644 containsno moving parts. The bar code scanner 2644 can be operated by manuallysweeping the scanner 2644 across a printed bar code or by any othersuitable means. In some embodiments, the bar code scanner 2644 includesan elongated housing in the shape of a wand.

The patient monitoring system 2630 includes a fluid system kit 2634connected to the monitoring apparatus 2632. In some embodiments, thefluid system kit 2634 includes fluidic tubes that connect a fluid sourceto an analytic subsystem. For example, the fluidic tubes can facilitatefluid communication between a blood source or a saline source and anassembly including a sample holder and/or a centrifuge. In someembodiments, the fluid system kit 2634 includes many of the componentsthat enable operation of the monitoring apparatus 2632. In someembodiments, the fluid system kit 2634 can be used with anti-clottingagents (such as heparin), saline, a saline infusion set, a patientcatheter, a port sharing IV infusion pump, and/or an infusion set for anIV infusion pump, any or all of which may be made by a variety ofmanufacturers. In some embodiments, the fluid system kit 2634 includes amonolithic housing that is sterile and disposable. In some embodiments,at least a portion of the fluid system kit 2634 is designed for singlepatient use. For example, the fluid system kit 2634 can be constructedsuch that it can be economically discarded and replaced with a new fluidsystem kit 2634 for every new patient to which the patient monitoringsystem 2630 is connected. In addition, at least a portion of the fluidsystem kit 2634 can be designed to be discarded after a certain periodof use, such as a day, several days, several hours, three days, acombination of hours and days such as, for example, three days and twohours, or some other period of time. Limiting the period of use of thefluid system kit 2634 may decrease the risk of malfunction, infection,or other conditions that can result from use of a medical apparatus foran extended period of time.

In some embodiments, the fluid system kit 2634 includes a connector witha luer fitting for connection to a saline source. The connector may be,for example, a three-inch pigtail connector. In some embodiments, thefluid system kit 2634 can be used with a variety of spikes and/or IVsets used to connect to a saline bag. In some embodiments, the fluidsystem kit 2634 also includes a three-inch pigtail connector with a luerfitting for connection to one or more IV pumps. In some embodiments, thefluid system kit 2634 can be used with one or more IV sets made by avariety of manufacturers, including IV sets obtained by a user of thefluid system kit 2634 for use with an infusion pump. In someembodiments, the fluid system kit 2634 includes a tube with a low deadvolume luer connector for attachment to a patient vascular access point.For example, the tube can be approximately seven feet in length and canbe configured to connect to a proximal port of a cardiovascularcatheter. In some embodiments, the fluid system kit 2634 can be usedwith a variety of cardiovascular catheters, which can be supplied, forexample, by a user of the fluid system kit 2634.

As shown in FIG. 26, the monitoring apparatus 2632 is connected to asupport apparatus 2636, such as an IV pole. The support apparatus 2636can be customized for use with the monitoring apparatus 2632. A vendorof the monitoring apparatus 2632 may choose to bundle the monitoringapparatus 2632 with a custom support apparatus 2636. In someembodiments, the support apparatus 2636 includes a mounting platform forthe monitoring apparatus 2632. The mounting platform can include mountsthat are adapted to engage threaded inserts in the monitoring apparatus2632. The support apparatus 2636 can also include one or morecylindrical sections having a diameter of a standard IV pole, forexample, so that other medical devices, such as IV pumps, can be mountedto the support apparatus. The support apparatus 2636 can also include aclamp adapted to secure the apparatus to a hospital bed, an ICU bed, oranother variety of patient conveyance device.

In the embodiment shown in FIG. 26, the monitoring apparatus 2632 iselectrically connected to an optional computer system 2646. The computersystem 2646 can comprise one or multiple computers, and it can be usedto communicate with one or more monitoring devices. In an ICUenvironment, the computer system 2646 can be connected to at least someof the monitoring devices in the ICU. The computer system 2646 can beused to control configurations and settings for multiple monitoringdevices (for example, the system can be used to keep configurations andsettings of a group of monitoring devices common). The computer system2646 can also run optional software, such as data analysis software2648, HIS interface software 2650, and insulin dosing software 2652.

In some embodiments, the computer system 2646 runs optional dataanalysis software 2648 that organizes and presents information obtainedfrom one or more monitoring devices. In some embodiments, the dataanalysis software 2648 collects and analyzes data from the monitoringdevices in an ICU. The data analysis software 2648 can also presentcharts, graphs, and statistics to a user of the computer system 2646.

In some embodiments, the computer system 2646 runs optional hospitalinformation system (HIS) interface software 2650 that provides aninterface point between one or more monitoring devices and an HIS. TheHIS interface software 2650 may also be capable of communicating databetween one or more monitoring devices and a laboratory informationsystem (LIS).

In some embodiments, the computer system 2646 runs optional insulindosing software 2652 that provides a platform for implementation of aninsulin dosing regimen. In some embodiments, the hospital tight glycemiccontrol protocol is included in the software. The protocol allowscomputation of proper insulin doses for a patient connected to amonitoring device 2646. The insulin dosing software 2652 can communicatewith the monitoring device 2646 to ensure that proper insulin doses arecalculated.

Analyte Control and Monitoring

In some embodiments, it may be advantageous to control a level of ananalyte (e.g., glucose) in a patient using an embodiment of an analytedetection system described herein. Although certain examples of glucosecontrol are described below, embodiments of the systems and methodsdisclosed herein may be used to monitor and/or control other analytes(e.g., lactate).

For example, diabetic individuals control their glucose levels byadministration of insulin. If a diabetic patient is admitted to ahospital or ICU, the patient may be in a condition in which he or shecannot self-administer insulin. Advantageously, embodiments of theanalyte detection systems disclosed herein may be used to control thelevel of glucose in the patient. Additionally, it has been found that amajority of patients admitted to the ICU exhibit hyperglycemia withouthaving diabetes. In such patients it may be beneficial to monitor andcontrol their blood glucose level to be within a particular range ofvalues. Further, it has been shown that tightly controlling bloodglucose levels to be within a stringent range may be beneficial topatients undergoing surgical procedures.

A patient admitted to the ICU or undergoing surgery may be administereda variety of drugs and fluids such as Hetastarch, intravenousantibiotics, intravenous glucose, intravenous insulin, intravenousfluids such as saline, etc., which may act as interferents and make itdifficult to determine the blood glucose level. Moreover, the presenceof additional drugs and fluids in the blood stream may require differentmethods for measuring and controlling blood glucose level. Also, thepatient may exhibit significant changes in hematocrit levels due toblood loss or internal hemorrhage, and there can be unexpected changesin the blood gas level or a rise in the level of bilirubin and ammonialevels in the event of an organ failure. Embodiments of the systems andmethods disclosed herein advantageously may be used to monitor andcontrol blood glucose (and/or other analytes) in the presence ofpossible interferents to estimation of glucose and for patientsexperiencing health problems.

In some environments, Tight Glycemic Control (TGC) can include: (1)substantially continuous monitoring (which can include periodicmonitoring, at relatively frequent intervals of every 1, 5, 15, 30, 45,and/or 60 minutes, for example) of glucose levels; (2) determination ofsubstances that tend to increase glucose levels (e.g., sugars such asdextrose) and/or decrease glucose levels (e.g., insulin); and/or (3)responsive delivery of one or more of such substances, if appropriateunder the controlling TGC protocol. For example, one possible TGCprotocol can be achieved by controlling glucose within a relativelynarrow range (for example between 70 mg/dL to 110 mg/dL). As will befurther described, in some embodiments, TGC may be achieved by using ananalyte monitoring system to make continuous and/or periodic butfrequent measurements of glucose levels.

In some embodiments, the analyte detection system schematicallyillustrated in FIGS. 4, 5, and 6 may be used to regulate theconcentration of one or more analytes in the sample in addition todetermining and monitoring the concentration of the one or moreanalytes. In some cases, the analyte detection system may be used in anICU to monitor (and/or control) analytes that may be present in patientsexperiencing trauma. In some implementations, the concentration of theanalytes is regulated to be within a certain range. The range may bepredetermined (e.g., according to a hospital protocol or a physician'srecommendation), or the range may be adjusted as conditions change.

In an example of glycemic control, a system can be used to determine andmonitor the concentration of glucose in the sample. If the concentrationof glucose falls below a lower threshold, glucose from an externalsource can be supplied. If the concentration of glucose increases abovean upper threshold, insulin from an external source can be supplied. Insome embodiments, glucose or insulin may be infused in a patientcontinuously over a certain time interval or may be injected in a largequantity at once (referred to as “bolus injection”).

In some embodiments, a glycemic control system may be capable ofdelivering glucose, dextrose, glycogen, and/or glucagon from an externalsource relatively quickly in the event of hypoglycemia. As discussed,embodiments of the glycemic control system may be capable of deliveringinsulin from an external source relatively quickly in the event ofhyperglycemia.

Returning to FIGS. 5 and 6, these figures schematically illustrateembodiments of a fluid handling system that comprise optional analytecontrol subsystems 2780. The analyte control subsystem 2780 may be usedfor providing control of an analyte such as, e.g., glucose, and mayprovide delivery of the analyte and/or related substances (e.g.,dextrose solution and/or insulin in the case of glucose). The analytecontrol subsystem 2780 comprises a source 2782 such as, for example, theanalyte (or a suitable compound related to the analyte) dissolved inwater or saline. For example, if the analyte is glucose, the source 2782may comprise a bag of dextrose solution (e.g., Dextrose or Dextrose50%). The source 2782 can be coupled to an infusion pump (not shown).The source 2782 and the infusion pump can be provided separately fromthe analyte control subsystem 2780. For example, a hospitaladvantageously can use existing dextrose bags and infusion pumps withthe subsystem 2780.

As schematically illustrated in FIGS. 5 and 6, the source 2782 is influid communication with the patient tube 512 via a tube 2784 andsuitable connectors. A pinch valve 2786 may be disposed adjacent thetube 2784 to regulate the flow of fluid from the source 2782. A patientinjection port can be located at a short distance from the proximal portof the central venous catheter or some other catheter connected to thepatient.

In an example implementation for glycemic control, if the analytedetection system determines that the level of glucose has fallen below alower threshold value (e.g., the patient is hypoglycemic), a controlsystem (e.g., the fluid system controller 405 in some embodiments)controlling an infusion delivery system may close the pinch valves 521and/or 542 to prevent infusion of insulin and/or saline into thepatient. The control system may open the pinch valve 2786 and dextrosesolution from the source 2782 can be infused (or alternatively injectedas a bolus) into the patient. After a suitable amount of dextrosesolution has been infused to the patient, the pinch valve 2786 can beclosed, and the pinch valves 521 and/or 542 can be opened to allow flowof insulin and/or saline. In some systems, the amount of dextrosesolution for infusion (or bolus injection) may be calculated based onone or more detected concentration levels of glucose. The source 2782advantageously may be located at a short enough fluidic distance fromthe patient such that dextrose can be delivered to the patient within atime period of about one to about ten minutes. In other embodiments, thesource 2782 can be located at the site where the patient tube 512interfaces with the patient so that dextrose can be delivered withinabout one minute.

If the analyte detection system determines that the level of glucose hasincreased above an upper threshold value (e.g., the patient ishyperglycemic), the control system may close the pinch valves 542 and/or2786 to prevent infusion of saline and/or dextrose into the patient. Thecontrol system may open the pinch valve 521, and insulin can be infused(or alternatively injected as a bolus) into the patient. After asuitable amount of insulin has been infused (or bolus injected) to thepatient, the control system can close the pinch valve 521 and open thepinch valves 542 and/or 2786 to allow flow of saline and/or glucose. Thesuitable amount of insulin may be calculated based on one or moredetected concentration levels of glucose in the patient. The insulinsource 518 advantageously may be located at a short enough fluidicdistance from the patient such that insulin can be delivered to thepatient within about one to about ten minutes. In other embodiments, theinsulin source 518 may be located at the site where the patient tube 512interfaces with the patient so that insulin can be delivered to thepatient within about one minute.

In some embodiments, sampling bodily fluid from a patient and providingmedication to the patient may be achieved through the same lines of thefluid handling system. For example, in some embodiments, a port to apatient can be shared by alternately drawing samples and medicatingthrough the same line. In some embodiments, a bolus can be provided tothe patient at regular intervals (in the same or different lines). Forexample, a bolus of insulin can be provided to a patient after meals. Inanother embodiment comprising a shared line, a bolus of medication canbe delivered when returning part of a body fluid sample back to thepatient. In some implementations, the bolus of medication is deliveredmidway between samples (e.g., every 7.5 minutes if samples are drawnevery 15 minutes). In other embodiment, a dual lumen tube can be used,wherein one lumen is used for the sample and the other lumen tomedicate. In yet another embodiment, an analyte detection system (e.g.,an “OptiScanner®” monitor) may provide suitable commands to a separateinsulin pump (on a shared port or different line).

Example Method for Glycemic Control

FIG. 27 is a flowchart that schematically illustrates an exampleembodiment of a method 2700 of providing analyte control. The exampleembodiment is directed toward one possible implementation for glycemiccontrol (including but not limited to tight glycemic control) and isintended to illustrate certain aspects of the method 2700 and is notintended to limit the scope of possible analyte control methods. Inblock 2705, a glucose monitoring apparatus (e.g., the monitoringapparatus 2632 of FIG. 26) draws a sample (e.g., a blood or blood plasmasample) from a sample source (e.g., a patient) and obtains a measurementfrom the sample (e.g., a portion of the drawn sample). The measurementmay comprise an optical measurement such as, for example, an infraredspectrum of the sample. In block 2710, the measurement sample isanalyzed to identify possible interferents to an estimation of theglucose concentration in the measurement sample. In block 2715, a modelis generated for estimating the glucose concentration from the obtainedmeasurement. In some embodiments, models developed from the algorithmsdescribe above with reference to FIGS. 21-23 are used. The generatedmodel may reduce or minimize effects of the identified interferents onthe estimated glucose concentration, in certain embodiments. In block2720, an estimated glucose concentration is determined from the modeland the obtained measurement. In block 2725, the estimated glucoseconcentration in the sample is compared to an acceptable range ofconcentrations. The acceptable range may be determined according to asuitable glycemic control protocol such as, for example, a TGC protocol.For example, in certain TGC protocols the acceptable range may be aglucose concentration in a range from about 70 mg/dL to about 110 mg/dL.If the estimated glucose concentration lies within the acceptable range,the method 2700 returns to block 2705 to obtain the next samplemeasurement, which may be made within about one to about thirty minutes(e.g., every fifteen minutes).

In block 2725, if the estimated glucose concentration is outside theacceptable range of concentrations, then the method 2700 proceeds toblock 2740 in which the estimated glucose concentration is compared witha desired glucose concentration. The desired glucose concentration maybe based on, for example, the acceptable range of glucoseconcentrations, the parameters of the particular glycemic protocol, thepatient's estimated glucose concentration, and so forth. If theestimated glucose concentration is below the desired concentration(e.g., the patient is hypoglycemic), a dose of dextrose to be deliveredto the patient is calculated in block 2745. This calculation may takeinto account various factors including, for example, one or moreestimated glucose concentrations, presence of additional drugs in thepatient's system, time taken for dextrose to be assimilated by thepatient, and the delivery method (e.g., continuous infusion or bolusinjection). In block 2750, a fluid delivery system (e.g., a system suchas the optional subsystem 2780 shown in FIGS. 5 and 6) delivers thecalculated dose of dextrose to the patient.

In block 2740, if the estimated glucose concentration is greater thanthe desired concentration (e.g., the patient is hyperglycemic), a doseof insulin to be delivered is calculated in block 2755. The dose ofinsulin may depend on various factors including, for example, one ormore estimated glucose concentrations in the patient, presence of otherdrugs, type of insulin used, time taken for insulin to be assimilated bythe patient, method of delivery (e.g., continuous infusion or bolusinjection), etc. In block 2750, a fluid delivery system (e.g., theoptional subsystem 2780 shown in FIGS. 5 and 6) delivers the calculateddose of insulin to the patient.

In block 2765, the method 2700 returns to block 2705 to await the startof the next measurement cycle, which may be within about one to aboutthirty minutes (e.g., every fifteen minutes). In some embodiments, thenext measurement cycle begins at a different time than normallyscheduled in cases in which the estimated glucose concentration liesoutside the acceptable range of concentrations under the glycemicprotocol. Such embodiments advantageously allow the system to monitorresponse of the patient to the delivered dose of dextrose (or insulin).In some such embodiments, the time between measurement cycles is reducedso the system can more accurately monitor analyte levels in the patient.

Examples of Some Possible Additional or Alternative Analytes

Although examples of control and/or monitoring has been described in theillustrative context of glycemic control, embodiments of the systems andmethods can be configured for control and/or monitoring of one or moreof many possible analytes, in addition to or instead of glucose. Monitorand/or control of analytes may be particularly helpful in ICUs, whichreceive patients experiencing trauma. For example, another parameterthat can be monitored is level of Hemoglobin (Hb). If the Hb level of apatient goes down without an apparent external reason, the patient couldbe suffering from internal bleeding. Indeed, many ICU patients (someestimate as many as 10%) suffer from what appears to be spontaneousinternal bleeding that may not be otherwise detectable until theconsequences are too drastic to easily overcome. In some embodiments,level of Hb can be measured indirectly, because its relationship tooxygen in the veins and arteries (at different points in the vasculaturewith respect to the heart and lungs) is understood. In some embodiments,the apparatus, systems and methods described herein can be useful formeasuring a level of Hb.

Another parameter that can be monitored is lactate level, which can berelated to sepsis or toxic shock. Indeed, high levels and/or rapid risein lactate levels can be correlated to organ failure and oxygenationproblems in the blood and organs. However, other direct measures of thebiological effects related to lactate level problems can be difficult tomeasure, for example, only becoming measurable with a delay (e.g., 2-6hours later). Thus, measurement of lactate level can help provide avaluable early warning of other medical problems. Indeed, if a problemwith lactate levels is detected, a nurse or doctor may be able toprevent the correlated problems by providing more fluids.

Another parameter that can be monitored is central venous oxygensaturation (ScvO2). It can be advantageous to try to maintain an ScvO2of 65-70% or greater in ICU patients (to help avoid sepsis, forexample). In some embodiments, the apparatus, systems, and methodsdescribed herein can be useful for measuring a level of ScvO2.

Levels of lactate and ScvO2 in a patient can be used together to provideinformation and/or warnings to a health care provider, which can beespecially useful in an ICU setting. For example, if lactate and ScvO2are both high, a warning can be provided (e.g., automatically using analarm). If lactate is high, but ScvO2 is low, a patient may benefit fromadditional fluids. If ScvO2 is high, but lactate is low, a cardiacproblem may be indicated. Thus, a system that provides information aboutboth lactate and ScvO2 can be very beneficial to a patient, especially,for example, in the ICU environment. Although lactate and ScvO2 havebeen used as an illustrative example, in other embodiments differentcombinations of analytes may be monitored and used to provideinformation and/or warnings to a health care provider.

Leak Detection

Various embodiments disclosed herein can relate to the measurement ofone or more analytes in a bodily fluid (e.g., blood) of a patient. Thebodily fluid can be drawn out of the patient and positioned within thesystem for processing and/or analysis, as discussed herein. A hole in afluid system can potentially allow outflow and/or inflow, depending onwhether a fluid pump system is increasing or decreasing the pressurewithin the system, and in particular whether the internal pressure isless than or greater than the external pressure. If a manufacturing,shipping, or use-based event causes an unexpected or undesired hole,problems can result. Thus, in some embodiments, it can be desirable tocheck the system for leaks, especially when the system is connecteddirectly to a patient (e.g., before drawing bodily fluid into thesystem).

Leaks can cause problems in a fluid system because they can reduce thepressure achieved by a hydraulic piston or syringe. Indeed, without astable and uncompromised fluid envelope, fluid movements urged by afluid pump of any kind can be unpredictable and difficult to engineer,predict, and control. For example, a system may be precisely engineeredto advance fluid by a certain linear distance within a fixed-diametertube by movement of a syringe pump having a wider diameter chamber by acorrelated distance. A leak can cause errors in that preciselyengineered system and can disrupt the expected correlation betweendistances, times, etc. Thus, leaks can introduce fluid movement andcontrol errors.

The leaked fluid can also present drawbacks. For example, fluid leakingout of the system can be dangerous to medical service providers andfluid leaking into the system can be potentially dangerous to thepatient using the system; undesirable leakage can flow both into and outof the system. In some instances, it is unknown whether a patient'sbodily fluid contains dangerous substances. Bodily fluid can potentiallyinclude dangerous substances (e.g., methicillin-resistant staphylococcusaureus (MRSA), human immunodeficiency virus (HIV), sepsis, bacterial orfungal infection, etc.). Many embodiments disclosed herein can be usedin connection with a critically ill or injured patient (e.g., in anintensive care unit in a hospital) in which infections can sometimesarise unexpectedly. In some instances, infections and other potentiallydangerous conditions can go undiagnosed. Moreover, a hole in the fluidsystem can also be a potential source to introduce unwanted substancesinto the fluid system and potentially into a patient. The types ofinfectious diseases that may be present on surfaces in a medical settingcan be more dangerous than in other settings because, for example,families of organisms can, over time, build resistances to treatmentprotocols. Many other drawbacks of leaks exist, including loss of fluid(both a patient's valuable bodily fluid and other expensivemedications), inefficiency of the fluid system, etc.

FIG. 28 is a flowchart showing an example embodiment of a method 2800for monitoring a patient while checking for leaks in the monitoringsystem. The method 2800 can be used in connection with variousembodiments disclosed herein (e.g., the apparatus 100, the system 400,the patient monitoring system 2630, and various other embodimentsdescribed herein). Indeed, some systems can use existing hardware tocheck for leaks by updating software and causing a controller toevaluate fluid envelope integrity using the fluid pumps and pressuresensors that also have different roles in the system. At bock 2802, thesystem can check for leaks, as described herein. At block 1804, thesystem can obtain a sample of bodily fluid. For example, the system candraw bodily fluid out of the patient, as described herein. At block2806, the system can measure the concentration of one or more analytes(e.g., glucose) in the sample of bodily fluid, as described herein.

The system can be configured to obtain multiple samples of bodily fluidand multiple measurements of the one or more analytes over time. Forexample, the system can be configured to periodically draw a sample ofbodily fluid and measure the concentration of the at least one analytein the sample (e.g., at least once every hour, every 45 minutes, every30 minutes, every 15 minutes, every 10 minutes, or less), as discussedherein. In some embodiments, the system can check for leaks (e.g., atblock 2802) for multiple cycles or of each cycle (e.g., before drawingbodily fluid into the system). With reference to the flowchart of FIG.28, after the system measures the concentration of the at least oneanalyte, the method 2800 can proceed back to block 2802 and the systemcan again check for leaks before obtaining another bodily fluid sample(at block 2804). In some embodiments, the system can check for leaksevery time the system is going to draw a sample of the bodily fluid. Insome embodiments, the system can be configured to check for leaksperiodically (e.g., every other sample draw, or every 3 sample draws,etc., once every hour, or once every 2 hours, etc.).

The method 2800 can include many additional features that are notspecifically shown in the flowchart of FIG. 28. For example, the method2800 can include separating the bodily fluid into a plurality ofcomponents (e.g., via a centrifuge and/or a filter). The method 2800 caninclude detecting and compensating for interferents to determine theconcentration of the at least one analyte. The method 2800 can includedisposing of the sample bodily fluid after the analysis (e.g., bytransporting the bodily fluid to a waste container 554). The method 2800can include various other features disclosed herein.

In some embodiments, a system can be configured to detect leaks byapplying pressure (negative or positive) to at least a portion of thefluid handling network using a fluid pump, such as a syringe pump forexample, and monitoring the pressure in the fluid handling network(e.g., using one or more pressure sensors). The application of pressurefor leak diagnosis can occur suddenly or gradually and can be maintainedfor a long or short duration. The pressure results can be compared tothe results from a standardized system known to have no leaks, or theycan be compared to results from the particular system (including, e.g.,a specific fluid handling cassette or cartridge) that may have beenmeasured previously when it was judged to have no leaks in amanufacturer's testing environment. Leak detection and analysis canoccur in discrete portions of a complex fluid system. For example, byopening and closing valves, different segments of a tubing system can beexposed to potential pressurization from a fluid pump, and also exposedto a fluid pressure sensor. Thus, the same pump and sensor may be usableto diagnose leaks in various fluid paths, even without moving the pumpand sensor. In some embodiments, more than one pump and/or more than onesensor can be used for such leak detection and analysis.

By way of example, the system can include an analyte measurement systemwhich can be configured to determine the concentration of at least oneanalyte in a fluid sample (e.g., bodily fluid drawn from a patient), asdiscussed herein. The analyte measurement system can include variousfeatures described in connection with the monitoring device 102, theanalyte detection systems described herein, etc. For example, theanalyte measurement system can be configured to optically analyze thefluid sample, e.g., using the optical system 412 or other opticalfeatures described herein.

The system can include a fluid handling system, which can includefeatures described in connection with various embodiments herein (e.g.,fluid handling system 404, fluid system 510, etc.). For example, a fluidhandling network can include a plurality of tubes (e.g., one or more ofthe tubes shown in FIG. 5 and/or FIG. 6, such as tubes 512, 514, 516,528, 530, 534, 540, 544, and/or 556). A patient end of the fluidhandling network can be configured to receive bodily fluid (e.g., thatis drawn from the patient) and to introduce the bodily fluid into thefluid handling network. The patient end can include a medical connectorconfigured to interface with a corresponding medical connector of anexternal system (e.g., which can be in communication with the patient'svasculature), an end of a tube that is configured to receive bodilyfluid into the system, a catheter or other component that is incommunication with the patient's vasculature, etc. The fluid handlingnetwork can include junctions between tubes (e.g., at connectors C1, C2,C3, C4, C5, C6, C7, C8, C9, C10, and/or C12 of FIG. 5 and/or FIG. 6). Insome instances, a leak can occur at a junction between tubes (e.g., atan interface between a connector and a tube), and the system can beconfigured to detect leaks at the junctions. The system can beconfigured to detect leaks at locations other than the junctions (e.g.,in the event a tube ruptures or develops a hole). The fluid handlingsystem can include various valves (e.g., the valves shown in FIG. 5and/or FIG. 6, such as valves 523, 529, 531, 533, 563, 566, 557, 561,503, 542, 521, 559, and/or 2786), which can be opened and closed todirect fluids along various paths through the fluid handling network.The system can include various pumps (e.g., the pumps shown in FIG. 5and/or FIG. 6, such as pumps 532, 522, 568, 588, and/or 599), which canbe configured to apply pressure to the fluid handling network (e.g., tomove liquid or air in the fluid handling network), as discussed herein.In some embodiments, the pumps can be syringe pumps, although othertypes of pumps can also be used. The system can include various sensors,as discussed herein and as shown in FIG. 5 and/or FIG. 6. In someembodiments, one or more pressure sensors (e.g., the pressure sensorsshown in FIG. 5 and/or FIG. 6, such as pressure sensors PS9, PS10, PS11,or PS12) can be used to measure the pressure in the fluid handlingnetwork.

FIG. 29 is a flowchart showing an example method 2900 for detectingwhether a leak is present in the fluid handling network. At block 2902,the system can isolate at least a portion of the fluid handling networkfrom the patient. For example, one or more valves can be closed to blockfluid communication between the patient end of the fluid handlingnetwork and at least a portion of the fluid handling network. In someembodiments, the valve 523 (V0) of FIG. 5 or the valve V0 a of FIG. 6can be closed to block fluid communication between the patient end andthe portion of the fluid handling network being tested. Other valves canbe closed to isolate at least a portion of the fluid handling network.For example, Tables 4-7, which are discussed below, show variouscombinations of valve states that can be used to isolate variousdifferent portions of the fluid handling network. In some embodiments,the fluid handling network is not in fluid communication with thepatient (e.g., the fluid sample can be delivered to an input end of thesystem by a source other than the patient), and the one or more valvescan close to isolate at least a portion of the fluid handling networkfrom the input end. One or more valves can close to isolate at least aportion of the fluid handling network from other components, such as thesaline source 520 (e.g., valve 542 (PV1)), the an air inlet (e.g., valve503 (PV0) of FIG. 5 or valve V3 b of FIG. 6), the waste container 554(e.g., valves 563 (V3 b) and/or 557 (V4 a) of FIG. 5 or valves 590, V2b, and/or V4 a of FIG. 6), the detergent tank 558 (e.g., valves 559 (V7b) and/or 561 (V4 b) of FIG. 5 or valves PV0, V4 b, and/or V7 b of FIG.6), and/or the heparin source (e.g., valve 589 (Vhep).

At block 2904, the system can apply pressure to the fluid handlingnetwork (e.g., using one or more pumps, such as pump #532 and/or pump #1522 shown in FIGS. 5 and 6). The at least one pump used to applypressure can be a syringe pump, although other types of pumps can beused. The at least one pump can be in fluid communication with theportion of the fluid handling network being tested for leaks. In someembodiments, the at least one pump can apply positive pressure to thefluid handling network (e.g., by driving additional fluid (e.g., salineor air) into the fluid handling network). In some embodiments, the atleast one pump can apply negative pressure to the fluid handling network(e.g., by drawing an amount of fluid (e.g., saline or air) out of thefluid handling network). In some embodiments, the system can beconfigured to apply more pressure to the fluid handling network (e.g.,more positive pressure or more negative pressure) during the leak testthan during the drawing and transporting of the fluid sample. Byapplying more pressure during the leak test than during the rest of themeasurement cycle, the leak test can be configured to identify potentialleaks so that the leaks don't materialize during while bodily fluid ismoving through the tubes. The leak detection can be a pressurized stresstest on the system. For example, if a seal or junction is weakened to apoint that it is close to being compromised to produce a leak, theelevated pressure of the leak test can compromise the seal or junctionto produce the leak during the leak test rather than during the drawingor transporting of bodily fluid.

At block 2906, the system can measure the pressure in the fluid handlingnetwork (e.g., using one or more pressure sensors, such as pressuresensor #10 505 and/or pressure sensor #9 507 shown in FIGS. 5 and 6).The one or more pressure sensors can be in fluid communication with theportion of the fluid handling network that is being tested (e.g., theportion that is isolated by one or more closed valves and in fluidcommunication with the one or more pumps applying pressure). The atleast one pressure sensor can monitor the pressure, e.g., by measuringthe pressure in the fluid handling network periodically (e.g., onceevery minute, once every 30 seconds, once every 15 seconds, once every 5seconds, once every 2 seconds, once every second, twice per second,three times per second, five times per second, 10 times per second,etc.). In some embodiments, the at least one pressure sensor can measurethe pressure in the fluid handling network on a substantially continuousbasis. The at least one pressure sensor can be used to monitor changesin the pressure in the fluid handling network over time. In someembodiments, the at least one pressure sensor does not monitor changesin the pressure over time, and the at least one pressure sensor can beconfigured to take a single measurement of the pressure (e.g., afterwaiting for a delay period after the pressure is applied at block 2904).

At block 2908, the system can determine whether a leak is present in theportion of the fluid handling network that is being tested (e.g., theportion that is isolated by one or more closed valves and in fluidcommunication with the one or more pumps applying pressure). In someembodiments, the system can test substantially the entire fluid handlingnetwork for leaks, or the system can test a portion of the fluidhandling network. The system can include a controller (e.g., the fluidsystem controller 405 discussed in connection with FIG. 4), which can beconfigured to perform the leak testing disclosed herein. The controller405 can include at least one computing device (e.g., at least onecomputer processor configured to execute machine-readable instructionsstored on at least one storage device to implement the featuresdescribed herein, and/or one or more integrated circuits specificallyconfigured to implement the features described herein). The controller405 can actuate the one or more valves and the at least one pump asdescribed herein.

The controller 405 can receive data from the at least one pressuresensor. The controller 405 can determine whether a leak is present inthe portion of the fluid handling network being tested based at least inpart on the data received from the at least one pressure sensor. Forexample, if pressure (e.g., positive or negative pressure) is applied tothe fluid handling network and the pressure sensor reports that thepressure (e.g., positive or negative pressure) is maintained at aconstant level or is within an expected pressure range, the controller405 can determine that no leak is present. If positive pressure isapplied and the at least one pressure sensor reports that the positivepressure is dropping over time or is below an expected pressure range orthreshold value, the controller 405 can determine that a leak is presentin the portion of the fluid handling network that is exposed to thepositive pressure. If negative pressure is applied to the fluid handlingnetwork and the pressure sensor reports that the negative pressure isrising over time or is above an expected pressure range or thresholdvalue, the controller 405 can determine that a leak is present in theportion of the fluid handling network that is exposed to the negativepressure. In some embodiments, a constant pressure can be an indicationof a leak, such as if the pressure remains substantially constant orchanges by less than an expected amount when the pressure is applied tothe fluid handling network at block 2904.

If no leak is detected, the method 2900 can proceed to block 2910, andthe system can proceed with normal operation of the measurement cycle.For example, the system can proceed to obtain a fluid sample (e.g., bydrawing bodily fluid from the patient and into the fluid handlingnetwork). Although not shown in FIG. 29, the method 2900 can continue toperform additional operations of the measurement cycle, such asmeasuring the concentration of at least one analyte in the fluid sample.In some embodiments, the system can check for leaks (e.g., as describedin connection with FIG. 29) before each time the system draws fluid intothe fluid handling network. If a leak is detected at block 2908, themethod 2900 can proceed to block 2912, and the system can post an alarm(e.g., indicating that a leak has been detected). The alarm can be, forexample, an audible alarm, a visual alarm (e.g., displayed on a displayof the system), or an electronic message sent to an external system(e.g., at a nurse station). In some embodiments, the system can ceaseoperation upon detection of a leak. For example, the system can beconfigured to not draw bodily fluid from a patient if a leak has beendetected in the system.

In some embodiments, the system can be configured to identify thelocation of a leak in the fluid handling network. FIG. 30 is a flowchartshowing an example method 3000 for identifying a location of a leak inthe fluid handling network. In some embodiments, the method 3000 can beperformed after a leak has been detected. In some embodiments, themethod 3000 can be performed as the test to determine whether or not thesystem has a leak. Accordingly, in some embodiments, the system candetect the presence of a leak and identify the location of the leakusing a single algorithm or process.

At block 3002, the system can isolate a first portion of the fluidhandling network (e.g., similar to block 2902 of FIG. 29). For example,one or more valves can be actuated to isolate the first portion of thefluid handling network from the patient, from the saline source 520,from an air inlet, and/or from other portions of the fluid handlingnetwork. In some instances the first portion of the fluid handlingnetwork can be only part of the fluid handling network, or the firstportion can include substantially the entire fluid handling network(e.g., the entire portion that the system is configured to test forleaks).

At block 3004, the system can apply pressure to the first portion of thefluid handling network (e.g., using at least one pump, such as similarto the manner described in connection with block 2904 of FIG. 29). Atblock 3006, the system can measure the pressure in the first portion ofthe fluid handling network (e.g., using at least one pressure sensor,such as similar to the manner described in connection with block 2906 ofFIG. 29).

At block 3008, the system can determine whether a leak is present in thefirst portion of the fluid handling network (e.g., using a controller405, such as similar to the manner described in connection with block2908 of FIG. 29).

At block 3010, the system can isolate a second portion of the fluidhandling network (e.g., similar to block 3002 of FIG. 30 and/or 2902 ofFIG. 29). For example, one or more valves can be actuated to isolate thesecond portion of the fluid handling network from the patient, from thesaline source 520, from an air inlet, and/or from other portions of thefluid handling network. In some instances the second portion of thefluid handling network can be only part of the fluid handling network,or the second portion can include substantially the entire fluidhandling network (e.g., the entire portion that the system is configuredto test for leaks). The second portion of the fluid handling network canbe different than the first portion of the fluid handling network. Thesecond portion of the fluid handling network can be a subset of thefirst portion of the fluid handling network, or the second portion ofthe fluid handling network can partially overlap with the first portionof the fluid handling network, or the first portion and the secondportion of the fluid handling network do not overlap and are separateportions of the fluid handling network.

At block 3012, the system can apply pressure to the second portion ofthe fluid handling network (e.g., using at least one pump, such assimilar to the manner described in connection with block 3004 of FIG. 30and/or block 2904 of FIG. 29). At block 3014, the system can measure thepressure in the second portion of the fluid handling network (e.g.,using at least one pressure sensor, such as similar to the mannerdescribed in connection with block 3006 of FIG. 30 and/or block 2906 ofFIG. 29). At block 3016, the system can determine whether a leak ispresent in the second portion of the fluid handling network (e.g., usinga controller 405, such as similar to the manner described in connectionwith block 2908 of FIG. 29).

At block 3018, the system can determine the location of a leak based atleast in part on the determinations of whether or not a leak was presentin the first portion of the fluid handling network and/or in the secondportion of the fluid handling network. For example, if the first portionof the fluid handling network is determined to have a leak and thesecond portion of the fluid handing network is determined to not have aleak, the controller 405 can determine, at block 3018, that the leak islocated in the part of the second portion of the fluid handling networkthat does not overlap with the first portion of the fluid handingnetwork. If the first portion of the fluid handling network isdetermined to have a leak and the second portion of the fluid handingnetwork is determined to have a leak, the controller 405 can determinethat the leak is located in the part of the fluid handling network wherethe first portion and the second portion overlap. In some embodiments,the system can output a message or code indicating the location of theleak.

Many variations are possible. In some embodiments, the operations ofblocks 3008 and/or 3016 can be omitted. For example, the system can beconfigured to determine a location of a leak directly from the measuredpressures from the first and second portions of the fluid handlingnetwork (e.g., without independently determining whether a leak ispresent in the first portion or in the second portion). The method 3000can include further operations not shown in FIG. 30 for isolating,pressurizing, measuring pressure in, and determining whether a leak ispresent in one or more additional portions of the fluid handlingnetwork, which can enable the system to better determine the location ofthe leak. The system can test 2, 3, 4, 5, 7, 10, 15, 20, or moredifferent portions of the fluid handling network to determine thelocation of a leak. For example, Table 4 identifies the connectors andother components that are tested for leaks using various differentcombinations of valve states when applying pressure using the pump #0532 in the embodiment of FIG. 5.

TABLE 4 Valve States for Leak Testing Pressure Applied By Pump #0 532 ofFIG. 5 V0 V1a V2b V3a V3b V4a V4b V7a V7b PV0 PV1 Tested Connectors — C— — C — — — C C — C5, C7 C O — C C — — C C C — C1, C5, C7 — C C C O C C— C C — C2, C3, C5, C6, C7 C O C O O C C C C C — C1, C2, C3, C5, C6, C7— C O C O O C — C C — C2, C3, C5, C6, C7, Waste C O O O O O C C C C —C1, C2, C3, C5, C6, C7, Waste — C — — C — C C O C C C4, C5, C7, TergTank C O — C C — C O O C C C1, C4, C5, C7, Terg Tank — C C C O C O C O CC C2, C3, C4, C5, C6, C7, Terg Tank — C O C O O O C O C C C2, C3, C4,C5, C6, C7, Waste, Terg Tank C O C O O C O O O C C C1, C2, C3, C4, C5,C6, C7, Terg Tank C O O O O O O O O C C C1, C2, C3, C4, C5, C6, C7,Waste, Terg Tank

By way of example, if the test of connectors C5 and C7 (row 1 of Table4) does not detect a leak and the test of connectors C1, C5, and C7 (row2 of Table 4) does detect a leak, the system can determine that a leakis likely present at the connector Cl. If the test of connectors C5 andC7 (row 1 of Table 4) does not detect a leak and the test of connectorsC2, C3, C5, C6, and C7 (row 3 of Table 4) does detect a leak, the systemcan determine that a leak is likely present at the one of the connectorsC2, C3, and C6. Comparing the results of tests of various other portionsof the fluid handling network can enable the system to identify leaks atvarious other locations.

Table 5 identifies the connectors and other components that are testedfor leaks using various different combinations of valve states whenapplying pressure using the pump #1 522 in the embodiment of FIG. 5.Comparing the results of tests of various portions of the fluid handlingnetwork (as shown in Tables 4 and 5) can enable the system to identifyleaks at various locations.

TABLE 5 Valve States for Leak Testing Pressure Applied By Pump #1 522 ofFIG. 5 V0 V1a V2b V3a V3b V4a V4b V7a V7b PV0 PV1 Tested Connectors — —— — — — C C C — C C4, Terg Tank C C — C — — C O C — C C1, C4, Terg Tank— — C C C C O C C — C C2, C3, C4, C6, Terg Tank C C C O C C O O C — CC1, C2, C3, C4, C6, Terg Tank — — O C C O O C C — C C2, C3, C4, C6,Waste, Terg Tank C C O O C O O O C — C C1, C2, C3, C4, C6, Waste, TergTank — C — — C — C C O C C C4, C5, C7, Terg Tank C O — C C — C O O C CC1, C4, C5, C7, Terg Tank — C C C O C O C O C C C2, C3, C4, C5, C6, C7,Terg Tank — C O C O O O C O C C C2, C3, C4, C5, C6, C7, Waste, Terg TankC O C O O C O O O C C C1, C2, C3, C4, C5, C6, C7, Terg Tank C O O O O OO O O C C C1, C2, C3, C4, C5, C6, C7, Waste, Terg Tank

Table 6 identifies the connectors that are tested for leaks usingvarious different combinations of valve states when applying pressureusing the pump #0 532 in the embodiment of FIG. 6. Table 7 identifiesthe connectors that are tested for leaks using various differentcombinations of valve states when applying pressure using the pump #0532 in the embodiment of FIG. 6. Comparing the results of tests ofvarious portions of the fluid handling network (as shown in Tables 6 and7) can enable the system to identify leaks at various locations.

TABLE 6 Valve States for Leak Testing Pressure Applied By Pump #0 532 ofFIG. 6 V1a V2a V2b V3a V4a V4b V7a V7b PV0 587 589 590 Tested ConnectorsC C — — — — — C — — — — C5, C7 O C — C — — C C — — — — C1, C5, C7 O C —O — — C C — C C C C1, C5, C6, C7 O C — C — — O C C — — — C1, C4, C5, C7O C — O — — O C C C C C C1, C4, C5, C6, C7 C O C — C C — C — C — — C2,C3, C5, C7, C8 O O C C C C C C — C — — C1, C2, C3, C5, C7, C8 O O C C CC O C C C — — C1, C2, C3, C4, C5, C7, C8 O O C O C C O C C O C C C1, C2,C3, C4, C5, C6, C7, C8 O O C O C C C C — O C C C1, C2, C3, C5, C6, C7,C8 C O C C C C — C — O C C C2, C3, C5, C6, C7, C8

TABLE 7 Valve States for Leak Testing Pressure Applied By Pump #1 522 ofFIG. 6 V1a V2a V2b V3a V4a V4b V7a V7b PV0 587 589 590 Tested Connectors— — — — — — C — C — — — C4 C — — C — — O — C — — — C1, C4 C — — O — — O— C C C C C1, C4, C6 C C C O C C O — C O C C C1, C2, C3, C4, C6, C8 O C— C — — O C C — — — C1, C4, C5, C7 O C — O — — O C C C C C C1, C4, C5,C6, C7 O O C C C C O C C C — — C1, C2, C3, C4, C5, C7, C8 O O C O C C OC C O C C C1, C2, C3, C4, C5, C6, C7, C8

In the embodiment of FIG. 6, the valves V0 a, PV1, and/or V3 b can beclosed (e.g., to isolate at least a portion of the fluid handlingnetwork from the patient, from the saline source, and/or from air) forall the tests shown in Table 6 and/or Table 7. For some rows, othervalves can prevent the pressure from reaching valves V0 a, PV1, and V3b, such that the valves V0 a, PV1, and V3 b can be either open orclosed. Accordingly, for sake of simplicity, the states of valves V0 a,PV1, and V3 b are not shown in Table 6 or Table 7.

It will be understood that the valve states shown in Tables 4-7 areexamples and that in some cases the same portion of the fluid handlingnetwork can be tested with multiple different settings. In the testsshown in some rows of Tables 4-7, a connector can be exposed to pressurefrom multiple tubes coupled to the connector, and the connector can alsobe tested by a different set of valve states that causes the pressure toreach the connector from a single tube. For example, in the bottom rowof Table 7, the same connectors C1, C2, C3, C4, C5, C6, C7, and C8 canbe tested even if valve V1 a were to be closed, or if valve V2 a were tobe closed, since the pressure from pump #1 522 can reach connectors C5and C7 through either of valves V1 a and V2 a.

Although tables 6 and 7 list only the connectors that are tested usingthe various combinations of valve states, various other components canbe tested as well, such as the various tubes in the fluid handlingnetwork, the sample cell, the detergent tank 558, and/or the wastecontainer 554. In some embodiments, certain components can be excludedfrom the test areas (e.g., by closing one or more valves). For example,in some cases the waste container 554 can be excluded from some or allof the tests (e.g., by closing valves such the valves 590, V2 b, and V4a), and/or the detergent tank 558 can be excluded from some or all ofthe tests (e.g., by closing valves such as valves PV0, V7 b, and V4 b).In some embodiments, excluding the waste container 554 and/or thedetergent tank 558 can improve the testing by increasing the stabilityof the pressure in the system. For example, in some instances the wastecontainer can expand, which can change the pressure in the system. Insome instances, the system can apply different pressures, or can applydifferent pressure ranges or threshold values depending on the portionof the fluid handling network being tested. For example, if the wastecontainer 554 is included in the area being tested, a larger acceptablepressure range can be used.

In some embodiments, leaks can be detected by measuring the length oftime it takes to draw sample of fluid or otherwise move fluid within thesystem. For example, an abrupt change (e.g., a lengthening of the timeperiod it takes fluid to reach a fluid sensor from a given startingpoint) can indicate a leak problem, assuming that other variables suchas tube size and fluid viscosity remain constant. Thus, one approach toleak detection is data analysis. Even if a change does not occurabruptly, it is possible that a leak or other degradation in the fluidenvelope can develop slowly. Accordingly, a gradual change in the lengthof time can also be investigated as a potential leak. For suchmeasurements, it can be particularly helpful to have one or more fluidsensors that can identify a boundary or a threshold, for example, aboundary between saline fluid and blood or a boundary between air andblood. That boundary can be tracked as a way of identifying how quicklyfluid has moved between two fixed positions in a fluid path. Forexample, with reference to FIGS. 5, the system can include a pluralityof arrival sensors (e.g., bubble sensor 509 (BS11), bubble sensor 535(BS9), bubble sensor 552 (BS14), arrival sensor 526 (HB12)), which canbe configured to detect the arrival of a fluid (e.g., bodily fluid suchas blood) at a plurality of locations in the fluid handling network.With reference to FIG. 6, the system can include a plurality of arrivalsensors (e.g., bubble sensor 509 (BS11), arrival sensor 511(BS8/SAT/Hb), bubble sensor 552 (BS14), arrival sensor 526 (HB12)),which can be configured to detect the arrival of a fluid (e.g., bodilyfluid such as blood) at a plurality of locations in the fluid handlingnetwork. In some embodiments, the sensors can be configured to detectthe departure of the fluid (e.g., bodily fluid such as blood) from theassociated locations in the fluid handling network.

In some embodiments, a start time can be established by the time thatthe fluid sample arrives at a starting point in the fluid handlingnetwork. An arrival sensor can be configured to detect the arrival ofthe fluid at the starting point. For example, with reference to FIG. 5,when the drawn fluid passes the bubble sensor 535 (BS 9) that canestablish a start time, and the arrival of the drawn fluid at the bubblesensor 552 (BS 14) that can establish a finish time. The time betweenthe finish time and the start time (e.g., the time that it took for thefluid to travel from the bubble sensor 535 (BS 9) to the bubble sensor552 (BS 14) can be used to determine whether there is a leak in thefluid handling network (e.g., between the bubble sensor 535 (BS 9) andthe bubble sensor 552 (BS 14). For example, if there is a leak in thefluid handing network, the pressure used to transport the fluid can bereduced, which can cause the fluid to move slower than expected. Manyvariations are possible. For example, if the system is configured tostop the movement of the fluid for an amount of time while the fluid isbetween the starting point the ending point, that amount of time can besubtracted from the time between the finish time and the start time inorder to establish the time it took to move the fluid from the startingpoint to the ending point. In some instances, the starting point is notassociated with a sensor. For example, with reference to FIG. 5, bodilyfluid can be drawn through the connector 524 (C1) into the tube 528(T4), and the system can then draw fluid out of the connector and intothe tube 534 (T3). Thus, in this example, the start time can beestablished as the time that the bodily fluid is drawn into the tube 534(T3) and the starting location can be established as the junctionbetween the tube 534 (T3) and the connector 524 (C1). The arrival of thebodily fluid at the bubble sensor 535 (BS 9) can establish a finishtime.

The time that it takes to transport the fluid from the starting locationto the end location can be compared to an acceptable time threshold todetermine whether the fluid handling network has a leak. The acceptabletime threshold and be a range, in some cases. In some embodiments, theacceptable time threshold can be the same for each cartridge used in thesystem. In some embodiments, the acceptable time threshold can bespecific to the cartridge type or to the individual cartridge. Thecartridge can include information regarding the acceptable timethreshold, and that information can be communicated to the system (e.g.,to the controller 405). For example, the cartridge can include a barcode, which can be scanned by a bar code reader to access informationabout the cartridge, including the acceptable time threshold for thecartridge. Thus, if different cartridges or cartridge types are testedand found to have different acceptable threshold times, that informationcan be used in detecting leaks.

In some embodiments, the time that it takes to transport the fluid fromthe starting location to the end location can be compared to one or moretimes that it took to transport the fluid from the starting location tothe end location during one or more previous measurement cycles. If thetime it takes to move the fluid from the starting location to the endinglocation changes by more than a threshold amount, or has a rate ofchange more than a threshold amount, etc., the system can determine thata leak may be present in the fluid handling system (or that some othermalfunction has occurred).

In some embodiments, the leak testing can be performed using data thatis generated from the normal operation of the system, e.g., withoutdedicated leak detection fluidics steps. For example, in some instances,the system does not actuate valves to isolate portions of the fluidhandling network and pressurize the portions of the fluid handingnetwork to test for leaks. Rather, the system merely transports thefluid as during normal operation (e.g., to deliver the fluid to thesample cell), and data generated by that transportation of the fluid canbe used to detect leaks. Accordingly, testing for leaks without anyadditional fluidics steps (e.g., without any additional valve actuationsor pump actuations) can extend the usable life of the cartridge and/orof the system.

Terminology and Conclusion

Reference throughout this specification to “some embodiments” or “anembodiment” means that a particular feature, structure or characteristicdescribed in connection with the embodiment is included in at least someembodiments. Thus, appearances of the phrases “in some embodiments” or“in an embodiment” in various places throughout this specification arenot necessarily all referring to the same embodiment and may refer toone or more of the same or different embodiments. Furthermore, theparticular features, structures or characteristics may be combined inany suitable manner, as would be apparent to one of ordinary skill inthe art from this disclosure, in one or more embodiments.

As used in this application, the terms “comprising,” “including,”“having,” and the like are synonymous and are used inclusively, in anopen-ended fashion, and do not exclude additional elements, features,acts, operations, and so forth. Also, the term “or” is used in itsinclusive sense (and not in its exclusive sense) so that when used, forexample, to connect a list of elements, the term “or” means one, some,or all of the elements in the list.

Similarly, it should be appreciated that in the above description ofembodiments, various features are sometimes grouped together in a singleembodiment, figure, or description thereof for the purpose ofstreamlining the disclosure and aiding in the understanding of one ormore of the various inventive aspects. This method of disclosure,however, is not to be interpreted as reflecting an intention that anyclaim require more features than are expressly recited in that claim.Rather, inventive aspects lie in a combination of fewer than allfeatures of any single foregoing disclosed embodiment.

Embodiments of the disclosed systems and methods may be used and/orimplemented with local and/or remote devices, components, and/ormodules. The term “remote” may include devices, components, and/ormodules not stored locally, for example, not accessible via a local bus.Thus, a remote device may include a device which is physically locatedin the same room and connected via a device such as a switch or a localarea network. In other situations, a remote device may also be locatedin a separate geographic area, such as, for example, in a differentlocation, building, city, country, and so forth.

Methods and processes described herein may be embodied in, and partiallyor fully automated via, software code modules executed by one or moregeneral and/or special purpose computers. The word “module” refers tologic embodied in hardware and/or firmware, or to a collection ofsoftware instructions, possibly having entry and exit points, written ina programming language, such as, for example, C or C++. A softwaremodule may be compiled and linked into an executable program, installedin a dynamically linked library, or may be written in an interpretedprogramming language such as, for example, BASIC, Perl, or Python. Itwill be appreciated that software modules may be callable from othermodules or from themselves, and/or may be invoked in response todetected events or interrupts. Software instructions may be embedded infirmware, such as an erasable programmable read-only memory (EPROM). Itwill be further appreciated that hardware modules may be comprised ofconnected logic units, such as gates and flip-flops, and/or may becomprised of programmable units, such as programmable gate arrays,application specific integrated circuits, and/or processors. The modulesdescribed herein are preferably implemented as software modules, but maybe represented in hardware and/or firmware. Moreover, although in someembodiments a module may be separately compiled, in other embodiments amodule may represent a subset of instructions of a separately compiledprogram, and may not have an interface available to other logicalprogram units.

In certain embodiments, code modules may be implemented and/or stored inany type of computer-readable medium or other computer storage device.In some systems, data (and/or metadata) input to the system, datagenerated by the system, and/or data used by the system can be stored inany type of computer data repository, such as a relational databaseand/or flat file system. Any of the systems, methods, and processesdescribed herein may include an interface configured to permitinteraction with patients, health care practitioners, administrators,other systems, components, programs, and so forth.

A number of applications, publications, and external documents may beincorporated by reference herein. Any conflict or contradiction betweena statement in the body text of this specification and a statement inany of the incorporated documents is to be resolved in favor of thestatement in the body text.

Although described in the illustrative context of certain preferredembodiments and examples, it will be understood by those skilled in theart that the disclosure extends beyond the specifically describedembodiments to other alternative embodiments and/or uses and obviousmodifications and equivalents. Thus, it is intended that the scope ofthe claims which follow should not be limited by the particularembodiments described above.

1. A bodily fluid sample analysis system comprising: an analytemeasurement system configured to determine the concentration of ananalyte in a bodily fluid; a fluid handling network comprising aplurality of tubes and at least one junction between the plurality oftubes, wherein the fluid handling network comprises a patient endconfigured to receive bodily fluid drawn from a patient, wherein thefluid handling network is configured to provide at least a portion ofthe drawn bodily fluid to the analyte measurement system; an arrivalsensor configured to detect the arrival of the bodily fluid at alocation in the fluid handling network; one or more valves having aclosed position and an open position; one or more pumps configured toapply pressure to the fluid handling network; at least one pressuresensor configured to measure pressure in the fluid handling network; anda controller configured to: actuate at least one of the one or morepumps to draw bodily fluid from a patient through the patient end intothe fluid handling network and to transport the bodily fluid to thelocation in the fluid handling network associated with the arrivalsensor; receive data from the arrival sensor indicating the arrival ofthe bodily fluid at the location; determine whether the fluid handlingnetwork is leaking based at least in part on the time that the bodilyfluid arrived at the location associated with the arrival sensor; closeat least one of the one or more valves to block fluid flow through atube between the patient end and the at least one junction; applypressure to the fluid handling network using the one or more pumps;receive data from the at least one pressure sensor regarding a pressurein the fluid handling network; confirm whether the fluid handlingnetwork is leaking based at least in part on the data received from theat least one pressure sensor; actuate the one or more valves to isolatea portion of the fluid handling network; apply pressure to the isolatedportion of the fluid handling network using the one or more pumps;receive data from the at least one pressure sensor regarding a pressurein the isolated portion of the fluid handling network; and determinewhether the isolated portion of the fluid handling network is leakingbased at least in part on the data received from the at least onepressure sensor.
 2. The system of claim 1, wherein the controller isconfigured to determine whether the fluid handling network is leakingbased at least in part on the time it takes for the bodily fluid to movefrom a starting point to the location associated with the arrivalsensor.
 3. The system of claim 2, further comprising a second arrivalsensor configured to detect the arrival of the bodily fluid at thestarting point, wherein the controller is configured to receive datafrom the second arrival sensor indicating the arrival of the bodilyfluid at the starting point.
 4. The system of claim 2, wherein thestarting point is a junction in the fluid handling network and wherein astart time comprises the time that the bodily fluid is drawn through thejunction.
 5. The system of claim 1, wherein the controller is configuredto determine whether the fluid handling network is leaking by comparingthe time that the bodily fluid arrived at the location with anacceptable time threshold.
 6. The system of claim 1, wherein thecontroller is configured to determine whether the fluid handling networkis leaking by comparing the time that the bodily fluid arrived at thelocation with one or more arrival times from one or more previousmeasurement cycles.
 7. The system of claim 1, wherein the controller isconfigured to cause a sample of bodily fluid to be received into thefluid handling network after determining that the fluid handling networkis not leaking.
 8. The system of claim 1, wherein the controller isconfigured to post an alarm after determining that the fluid handlingnetwork is leaking.
 9. The system of claim 1, wherein the system isconfigured to perform a plurality of measurement cycles, and wherein thesystem is configured to check the fluid handling network for leaksbefore receiving a fluid sample into the fluid handling network for eachmeasurement cycle.
 10. The system of claim 1, wherein the controller isconfigured to: isolate a first portion of the fluid handling network;apply pressure to the first portion of the fluid handling network;measure a pressure in the first portion of the fluid handling network;isolate a second portion of the fluid handling network; apply pressureto the second portion of the fluid handling network; measure a pressurein the second portion of the fluid handling network; and determine alocation of a leak based at least in part on the measured pressure ofthe first portion of the fluid handling network and the measuredpressure of the second portion of the fluid handling network.
 11. Thesystem of claim 10, wherein the first portion of the fluid handlingnetwork overlaps at least part of the second portion of the fluidhandling network.
 12. The system of claim 10, wherein the first portionof the fluid handling network and the second portion of the fluidhandling network do not overlap.
 13. The system of claim 10, wherein thecontroller is configured to: determine whether a leak is present in thefirst portion of the fluid handling network based at least in part onthe measured pressure in the first portion of the fluid handlingnetwork; and determine whether a leak is present in the second portionof the fluid handling network based at least in part on the measuredpressure in the second portion of the fluid handling network.
 14. Thesystem of claim 10, wherein the controller is configured to output anindicator of the location of the leak.
 15. The system of claim 1,wherein the controller is configured to apply more pressure to the fluidhandling network when testing for leaks than when providing the at leasta portion of the fluid sample to the analyte measurement system.
 16. Thesystem of claim 1, wherein the analyte comprises glucose.
 17. The systemof claim 1, wherein the fluid sample comprises whole blood.
 18. Apatient monitoring system comprising: an analyte measurement systemconfigured to determine the concentration of an analyte in a bodilyfluid; a fluid handling network comprising a plurality of tubes and atleast one junction between the plurality of tubes, wherein the fluidhandling network comprises a patient end configured to receive bodilyfluid drawn from a patient, and wherein the fluid handling network isconfigured to provide at least a portion of the drawn bodily fluid tothe analyte measurement system; a valve having a closed position and anopen position, wherein the closed position blocks fluid flow through atube between the patient end and the at least one junction, and whereinthe open position permits fluid flow through the tube between thepatient end and the at least one junction; at least one pump configuredto apply pressure to the fluid handling network; at least one pressuresensor configured to measure pressure in the fluid handling network; anda controller configured to: close the valve to block fluid flow throughthe tube between the patient end and the at least one junction; applypressure to the fluid handling network through the junction using the atleast one pump; receive data from the at least one pressure sensorregarding a pressure in the fluid handling network; and determinewhether the fluid handling network is leaking based at least in part onthe data received from the at least one pressure sensor.
 19. The patientmonitoring system of claim 18, wherein the controller is configured tocause a sample of bodily fluid to be drawn into the fluid handlingnetwork after determining that the fluid handling network is notleaking.
 20. The patient monitoring system of claim 18, wherein thecontroller is configured to post an alarm after determining that thefluid handling network is leaking.
 21. The patient monitoring system ofclaim 18, wherein the system is configured to perform a plurality ofmeasurement cycles, and wherein the system is configured to check thefluid handling network for leaks before drawing bodily fluid into thefluid handling network for each measurement cycle.
 22. The patientmonitoring system of claim 18, wherein the controller is configured to:actuate one or more valves to isolate a first portion of the fluidhandling network; apply pressure to the first portion of the fluidhandling network using the at least one pump; measure a pressure in thefirst portion of the fluid handling network using the at least onepressure sensor; actuate the one or more valves to isolate a secondportion of the fluid handling network; apply pressure to the secondportion of the fluid handling network using the at least one pump;measure a pressure in the second portion of the fluid handling networkusing the at least one pressure sensor; and determine a location of aleak based at least in part on the measured pressure of the firstportion of the fluid handling network and the measured pressure of thesecond portion of the fluid handling network.
 23. The patient monitoringsystem of claim 22, wherein the first portion of the fluid handlingnetwork overlaps at least part of the second portion of the fluidhandling network.
 24. The patient monitoring system of claim 22, whereinthe first portion of the fluid handling network and the second portionof the fluid handling network do not overlap.
 25. The patient monitoringsystem of claim 22, wherein the controller is configured to: determinewhether a leak is present in the first portion of the fluid handlingnetwork based at least in part on the measured pressure in the firstportion of the fluid handling network; and determine whether a leak ispresent in the second portion of the fluid handling network based atleast in part on the measured pressure in the second portion of thefluid handling network.
 26. The patient monitoring system of claim 22,wherein the controller is configured to output an indicator of thelocation of the leak.
 27. The patient monitoring system of claim 18,wherein the controller is configured to apply more pressure to the fluidhandling network when testing for leaks than when drawing bodily fluidor when providing the at least a portion of the drawn bodily fluid tothe analyte measurement system.
 28. The patient monitoring system ofclaim 18, wherein the analyte comprises glucose.
 29. The patientmonitoring system of claim 18, wherein the bodily fluid comprises wholeblood.
 30. A method comprising: using an analyte measurement system todetermine the concentration of an analyte in a fluid sample; using afluid handling network to receive a fluid sample and to provide at leasta portion of the fluid sample to the analyte measurement system;actuating one or more valves to isolate a first portion of the fluidhandling network; applying pressure to the isolated first portion of thefluid handling network using at least one pump; receiving receive datafrom the at least one pressure sensor to measure a pressure in theisolated first portion of the fluid handling network; and determiningwhether the isolated first portion of the fluid handling network isleaking based at least in part on the data received from the at leastone pressure sensor, isolating a second portion of the fluid handlingnetwork; applying pressure to the isolated second portion of the fluidhandling network; measuring a pressure in the isolated second portion ofthe fluid handling network; and determining a location of a leak basedat least in part on the measured pressure of the isolated first portionof the fluid handling network and the measured pressure of the isolatedsecond portion of the fluid handling network.
 31. (canceled)
 32. Themethod of claim 30, comprising posting an alarm after determining thatthe fluid handling network is leaking.
 33. The method of claim 30,comprising performing a plurality of measurement cycles, and checkingthe fluid handling network for leaks before receiving a fluid sampleinto the fluid handling network for each measurement cycle. 34.(canceled)
 35. The method of claim 30, wherein the isolated firstportion of the fluid handling network overlaps at least part of theisolated second portion of the fluid handling network.
 36. The method ofclaim 30, wherein the first portion of the fluid handling network andthe second portion of the fluid handling network do not overlap.
 37. Themethod of claim 30, comprising: determining whether a leak is present inthe first portion of the fluid handling network based at least in parton the measured pressure in the first portion of the fluid handlingnetwork; and determining whether a leak is present in the second portionof the fluid handling network based at least in part on the measuredpressure in the second portion of the fluid handling network.
 38. Themethod of claim 30, comprising outputting an indicator of the locationof the leak.
 39. The method of claim 30, comprising applying morepressure to the fluid handling network when testing for leaks than whenproviding the at least a portion of the fluid sample to the analytemeasurement system.
 40. The method of claim 30, wherein the analytecomprises glucose.
 41. The method of claim 30, wherein the fluid samplecomprises whole blood.
 42. A patient monitoring system comprising: ananalyte measurement system configured to determine the concentration ofan analyte in a bodily fluid; a fluid handling network comprising aplurality of tubes, wherein the fluid handling network is configured todraw bodily fluid from a patient and to provide at least a portion ofthe drawn bodily fluid to the analyte measurement system; an arrivalsensor configured to detect the arrival of the bodily fluid at alocation in the fluid handling network; and a controller configured to:actuate at least one pump to draw bodily fluid from a patient into thefluid handling network and to transport the bodily fluid to the locationin the fluid handling network associated with the arrival sensor;receive data from the arrival sensor indicating the arrival of thebodily fluid at the location; and determine whether the fluid handlingnetwork is leaking based at least in part on the time that the bodilyfluid arrived at the location associated with the arrival sensor. 43.The system of claim 42, wherein the controller is configured todetermine whether the fluid handling network is leaking based at leastin part on the time it takes for the bodily fluid to move from astarting point to the location associated with the arrival sensor. 44.The system of claim 43, further comprising a second arrival sensorconfigured to detect the arrival of the bodily fluid at the startingpoint, wherein the controller is configured to receive data from thesecond arrival sensor indicating the arrival of the bodily fluid at thestarting point.
 45. The system of claim 43, wherein the starting pointis a junction in the fluid handling network and wherein a start timecomprises the time that the bodily fluid is drawn through the junction.46. The system of claim 42, wherein the controller is configured todetermine whether the fluid handling network is leaking by comparing thetime that the bodily fluid arrived at the location with an acceptabletime threshold.
 47. The system of claim 42, wherein the controller isconfigured to determine whether the fluid handling network is leaking bycomparing the time that the bodily fluid arrived at the location withone or more arrival times from one or more previous measurement cycles.